Journal of clinical and diagnostic research

Structured Pulmonary Rehabilitation in a Patient with Post Tuberculosis Bronchiectasis and Endobronchial Carcinoid

Purva Gulrandhe, Vishakha Tayade, Vishnu Vardhan

Pulmonary Tuberculosis (TB) has the potential to harm the lungs over long-term owing to complication such as bronchiectasis. However, authors hereby reported a case of endobronchial carcinoid, for which there was a need for a tailored and planned physiotherapy intervention to address such a challenging condition. Loss of lung functions, a decline in exercise tolerance, and/or chronic respiratory symptoms due to TB-related interstitial and structural alterations have been identified as sequelae to pulmonary TB. A 52-year-old female presented with the chief complain of breathlessness of grade 3 on the Modified Medical Research Council (MMRC) scale, chest pain over left-side radiating to the neck, and cough with expectoration. She had loss of appetite and high-grade fever and was diagnosed with endobronchial carcinoid with upper and middle lobe consolidation with cystic bronchiectasis. The patient received pharmacological treatment with bronchodialators, mucolytics, antibiotics, and non opoid analgesics. The goals of physiotherapeutic management included secretion removal, relieving dyspnoea, providing relaxation, enhancing exercise capacity through impacts on aerobic capacity and, management of disease, and Quality of Life (QoL) improvement. The structured rehabilitation programme was found to be effective at the end of eight weeks. Clinical improvement was observed in the patient but complete rehabilitation was not able to achieve due to the patient’s socioeconomic condition.

Seizure-Induced Coma in Patient with Haemoglobin 1.3 gram per decilitre and Multi-Organ Dysfunction: A Rare Case Report

Shrdhha Agrawal, Akhilesh Singh Parihar, Charuta Gadkari

People of all ages are affected by anaemia which is a serious global health problem. Iron Deficiency Anaemia (IDA) seems to be the most commonly occurring type of anaemia in women. Elderly people with anaemia have higher morbidity and mortality. The purpose of treatment is to tackle the disorder’s underlying cause. Older people with persistent anaemia may need regular blood transfusions. The authors present a case report of a 55-year-old woman who visited the Emergency Department with primary complaints of convulsions and subsequent unconsciousness. She had generalised oedema and weakness since eight days. On examination, she was afebrile with pulse rate of 92 beats/min, Systolic Blood Pressure (SBP) of 80 mmHg. Laboratory results showed haemoglobin of 1.3 g/dL, increased White Blood Cells (WBC) and peripheral smear showed pencil-shaped cells and teardrop cells. Radiological investigation showed grade III renal parenchymal disease, cirrhosis of liver, gross ascites with bilateral pleural effusion, and splenic cyst. A 2D Echocardiography was done, which was suggestive of left ventricular hypertrophy, mild to moderate systolic dysfunction, along with dilated left ventricle. She was intubated in view of low Glasgow Coma Scale (GCS) and unconsciousness. On further stay in the hospital, she received blood transfusion. Hence, this case is a rare finding of severe anaemia.

Unilateral Traumatic Atresia of External Auditory Canal: A Case Report

Priya Kanagamuthu, Sandeep Unnikrishnan, Raghvi Anand

External Auditory Canal (EAC) atresia, which can be acquired or congenital, is a condition in which the EAC is not present. A blind sac in the external acoustic meatus is the result of intraluminal or extraluminal processes of various aetiologies, which can lead to acquired atresia of the EAC. Acquired EAC atresia is a rare disorder of the EAC, and it is extremely uncommon for it to be brought on by direct trauma. In present investigation, a 31-year-old female patient, leading to onset of right temporal discomfort and impaired hearing in the right ear. On examination, a 10×1 cm tender scar was present extending from right parietal region till right zygomatic arch with stenosis in the right external auditory meatus. Facial nerve examination revealed loss of wrinkling on right side with slight deviation of the angle of mouth to left side. High Resolution Computed Tomography (HRCT) temporal bone showed soft tissue causing complete occlusion of right EAC. Patient underwent right EAC atresiaplasty with canaloplasty and canal reconstruction. Facial nerve weakness persisted postoperatively. Patient is still on follow-up and has improved symptomatically with no restenosis. Surgical management of EAC atresia is very challenging, thus it needs meticulous planning and long term follow-up for good results which was evident in the present case.

Scrape to Nail the Diagnosis: A “Mitey” Challenge in an Erythroderma

S Praveen Kumar, TK Sumathy, AL Shyam Prasad, Archana Lakshman

Norwegian (crusted) scabies is a highly contagious form of scabies which can evolve into erythroderma at times. We herein report a case of a 29-year-old male patient, an established case of Epidermolysis Bullosa Dystrophica (EBD), presented to us with asymptomatic generalised scaling and crusting of two months duration. On examination patient also had dystrophic nails, anonychia and joint contractures. With a high index of suspicion, a scraping for KOH mount was done, which showed numerous scabies mites, eggs and faecal pellets. The patient was started on weekly oral Ivermectin (200 mcg/kg) and topical 5% permethrin application. There was dramatic response within 1-2 weeks. This case is presented to highlight the diagnostic challenge that erythroderma may be due to Norwegian scabies or the primary entity- EBD. The association of EBD and Norwegian scabies has been reported in literature. A simple bedside test like scraping can nail the diagnosis, provided there is a high index of suspicion.

Full Mouth Rehabilitation of a Post COVID-19 Mucormycosis Treated Patient using Bar- Retained Prosthesis: A Case Report

During the second wave of Coronavirus Disease-2019 (COVID-19), the Indian subcontinent witnessed a steep rise in post-COVID mucormycosis cases, with an alarming rate of about 70 times higher than the rest of the world. Maxillofacial defects amounted to various post-surgical hindrances such as difficulty in mastication, impaired speech, nasal regurgitation, mental despair and socially awkward situations. Dentists worldwide faced the challenge of fabricating a well-retained and functionally comfortable prosthesis to improve the condition of physiologically debilitating and psychologically impaired patient. In this case report, the authors present the full mouth rehabilitation of a 65-year-old male patient who had been treated for post-COVID mucormycosis. A bar-retained prosthesis was delivered, which was non-invasive, highly retentive, and pocket-friendly for the patient. This case report also shows that through meticulous planning and execution of the treatment plan, one can achieve the desired results and meet the patient’s expectations.

Monoclonal Gammopathy of Undetermined Significance with Three Bands on Serum Protein Electrophoresis: An Atypical Presentation

Rashmi Rasi Datta, Ashutosh Awasthi

Monoclonal Gammopathy (MGM) is a group of B-cell disorders characterised by secretion of abnormal monoclonal Immunoglobulin (Ig) that can be detected by presence of M-protein in serum and urine electrophoresis. Monoclonal protein (M-protein) can be best identified by high resolution agarose gel electrophoresis where, it is usually perceived as a discrete band in the γ or β globulin region. Sometimes atypical banding patterns are seen in serum capillary electrophoresis that pose diagnostic dilemmas and may require repeat testing and further confirmation with a diagnostic test. In the present case, a 60-year-old female patient was advised assessment for gammopathies owing to the presence of skeletal lesions and hyperproteinaemia clinically. Serum protein capillary electrophoresis revealed an unusual pattern with three prominent bands in the beta/early gamma region, indicative of triclonal gammopathy, although, it was monoclonal in nature which was depicted during confirmatory diagnostic testing. The authors further discuss the multiple aspects that may be attributed as a cause for such peculiar presentations which should be considered to avoid misdiagnosis.

Unusually Large Nasopalatine Duct Cyst: A Case Report

Palatal swellings can at times be a challenging task for clinicians to diagnose, as they may result from various aetiological factors and can derive from the structures within palate or beyond it, either be congenital or acquired in origin. Nasopalatine duct cysts are the most common developmental non-odontogenic cysts account for 10% of maxillary cysts in oral cavity. Though exact aetiology is unknown, these cysts commonly arise from epithelial remnants of nasopalatine duct and usually present as asymptomatic swelling in anterior part of hard palate posterior to the palatal papilla. A unique case report of 28-year-old male patient manifested with a large palatal swelling in the middle of the hard palate with associated symptoms of burning sensation in nose, difficulty while swallowing and change in voice resonance. Radiographic findings revealed well-defined radiolucency in anterior maxilla causing disruption in nasal cavity with histopathological evidence of nasopalatine duct cyst is presented.

Kounis Syndrome: Is it a Heralder or Just a Mimicker of Acute Coronary Syndrome?

Coronary vasospasm of allergic aetiology is a heavily underdiagnosed condition. Very few instances of this phenomenon are reported. This is a case of a 55-year-old male, with an unusual presentation, where a bee sting triggered an allergic inflammatory reaction, leading to release of inflammatory cytokines resulting in coronary vasospasm. This is evidenced by ST segment elevations at the time of presentation. These ST segment changes resolves on taking antihistaminic and corticosteroid medication. The resolution of symptoms and Electrocardiogram (ECG) findings after treatment with antihistaminic and corticosteroid proved that, the symptoms were primarily caused by an allergic reaction. The present case report explained that, coronary vasospasm can occur due to hypersensitivity reactions and can be treated promptly with antihistaminic and immunosuppressive (hydrocortisone) drugs.

Soft Tissue Ridge Augmentation Around Implant Using Modified Pouch Approach: A Case Report

Aparna Kaushik , Nishi Tanwar , Rajinder Kumar Sharma , Shikha Tewari

Common clinical findings around dental implants are hard and soft tissue defects requiring interventions for functional and aesthetic purposes. Interventions include hard as well as soft tissue augmentation. Present case management included subepithelial connective tissue grafting with modification of lateral pouch graft procedure, avoiding the vertical incisions. To the best of our knowledge, this is the first case report of this modified procedure. A 24-year-old female patient was referred by the prosthodontist for soft tissue augmentation after implant placement with respect to #24. With the consent of patient, subepithelial connective tissue graft was placed using modified lateral pouch graft procedure. Patient was evaluated at three months. Adequate soft tissue thickness was obtained with satisfactory results. This modified pouch graft procedure is expected to provide better aesthetic results. This procedure can be best utilised for small horizontal ridge defects. This is a novel approach for soft tissue augmentation without using vertical incisions thus providing better aesthetic results. Further studies are suggested regarding the long term success of the procedure.

Traumatic Intraoral Herniation of Buccal Fat Pad: A Case Report

Daksh Manish Kedia, Rajesh Kshirsagar, Vivek Nair, Gaurav Jha

Intraoral herniation of the Buccal Fat Pad (BFP) is a rarely encountered injury in the paediatric group population. A 24-month-old girl was brought to the Emergency Department by her parents. The parents reported an alleged history of intraoral trauma while playing with a wooden ice-cream stick approximately 14 hours ago. The intraoral examination revealed a yellowish blood-tinged pedunculated mass of soft tissue which was non tender, non pulsatile and appeared to be emanating from the left buccal mucosa. She was immediately hospitalised and necessary investigations were performed. The patient was taken up for surgical intervention under general anaesthesia. The protruding mass, an extension of the BFP, was thoroughly cleansed and repositioned into its normal anatomic position through the existing laceration. The site healed with no post-operative complication in spite of the delayed repositioning.

Anaesthetic Management of Pyelolithotomy Patient with Restricted Mouth Opening due to Previous Mandibular Surgery- A Case Report

Kala Balasubramanian, Bhagya Vardhan Botta

Anaesthetic management of a patient with compromised kidney function, who had restricted mouth opening due to previous surgery for mandibular fracture requiring general anaesthesia, is a challenge for anaesthesiologists. This is a case report of a 45-year-old male patient with renal calculus who underwent left pyelolithotomy surgery under general anaesthesia at our institution. He was admitted with left loin pain of two weeks’ duration. Airway control was difficult due to limited mouth opening resulting from mandibular fracture four months prior, for which he underwent open reduction and internal fixation at a different hospital. We anticipated difficulty in securing the airway due to mandibular plate fixation. The airway was secured with orotracheal intubation using a levitan optical stylet under airway block. This case report highlights the importance of optical stylet in the plan B of managing a difficult airway, when a fiberoptic bronchoscope is not available in a critical situation.

Granulomatous Appendicitis- A Rare Case Report

Suyash Rastogi, Usha Muniyappa

In 1953, Meyerding and Bertram were the first individuals to report non-specific granulomatous inflammation in the appendix. Granulomatous appendicitis is a rare condition, accounting for less than 2% of cases. However, idiopathic granulomatous appendicitis is very rare, and diagnosis is usually made by excluding all other conditions. It is challenging to diagnose tuberculous appendicitis based on clinical findings, hence histopathological examination is required. Hereby, authors report a case of 26-year-old male who presented with pain abdomen in the Department of Surgery. On imaging, appendix was thickened, and acute appendicitis was considered as a probable diagnosis. On histopathological examination, it was diagnosed as granulomatous inflammation suggestive of tuberculosis. The present case is presented for its rarity as appendicitis is considered as an abdominal emergency, so prompt management and diagnosis is required by excluding all other causes of granulomatous inflammation in appendix.

Physical Rehabilitation of Patient with Infrarenal Abdominal Aortic Aneurysm Presenting with Hydrocele and Inguinal Hernia: A Case Report

Dhanush Kotian, Abeeshna Ashok

Infrarenal Abdominal Aortic Aneurysm (AAA) is an abnormal dilation of distal abdominal aorta. The risk factors are age older than 60 years, smoking, hypertension and caucasian ethnicity. Testicular pain is an uncommon clinical presentation. There is a high prevalence of inguinal hernia in patients with infrarenal AAA. The purpose of the present case report is to describe the functional activity limitation in a patient affected by an infrarenal AAA presenting as a symptom of inguinal hernia and groin pain despite successful infrarenal AAA repair with aortofemoral bypass surgery and bilateral inguinal hernia repair. A 62-year-old male patient, presented with pain in the groin region and mild swelling over the scrotal region, which was severely limiting his activities of daily living. A Computerised Tomography (CT) angio abdomen revealed a fusiform aneurysm on the distal abdominal aorta and a saccular aneurysm of bilateral common iliac arteries. Given the minimum of four days of referral waiting time to receive treatment for infrarenal AAA, the patient underwent surgery and was followed by the postoperative physiotherapy intervention. The rehabilitation programme started five days postsurgery. The treatment goals directed mainly decreasing postoperative pulmonary complications and improving functional mobility. The present case report contributes new light on the possible pathogenesis and timely management. It reports the unexpected and unusual presentation of the disease and unveiling the link between the presentation of infrarenal AAA and inguinal hernia and hydrocele.

Hereditary Sensory and Autonomic Neuropathy V: A Case Report

GK Pallavi URS, Gaurav M URS, Varsha V Hebbar, Vibha Konanur

Hereditary Sensory and Autonomic Neuropathy (HSAN) are a group of rare inherited disorders that comprises a varied set of disorders which mainly present with sensory dysfunction and deficits in autonomic functions, along with other associated manifestations. This case report describes the case of a four-year-old male child, who was referred to the Department of Paediatric Neurology and Pedodontics due to loss of multiple teeth and drooling of saliva, coupled with multiple oral ulcers that worsened over time. During the assessment, sensory and autonomic abnormalities were observed, while the remaining systems were normal. Following a strong clinical suspicion and the involvement of a geneticist, a genetic analysis yielded the diagnosis of HSAN V. Given its rarity and varied presentation, reporting this case would help to open discussions on diagnostic and therapeutic dilemmas involved in treating these children, which usually comprises a multidisciplinary team, consisting mainly of dental and neurology departments.

Obstructive Uropathy Caused by Chryseobacterium indologenes : A Case Series from University Hospital, Uttar Pradesh, India

Akanksha Dubey, Mitra Kar, Tasneem Siddiqui, Chinmoy Sahu

Chryseobacterium spp., is non motile, non fermenter, Gram Negative Bacillus (GNB) showing enzymatic activity of catalase, oxidase, and indole production. Chryseobacterium spp. are found widely in the soil and aquatic milieu. It is also capable of surviving in chlorinated water, which can be attributed to the spread of infection in hospital settings hosting profusely immunosuppressed individuals. Newer diagnostic modalities like Matrix-Assisted Laser Desorption Ionisation-Time Of Flight-Mass Spectrometry (MALDI-TOF-MS) and Vitek-2 facilitate early identification and treatment can alleviate the infections caused by them. Present series discusses three cases of Chryseobacterium indologenes (C. indologenes) Urinary Tract Infection (UTI) Case 1- was a 61-year-old hypertensive and diabetic male patient diagnosed with renal failure with pyelonephritis. Case 2- was a female patient of 64-year-old with left upper ureteric calculus. Case 3- was a 31-year-old male patient having left mid ureteric calculus. All the patients were catheterised with a urinary catheter and developed UTI by C. indologenes. C. indologenes infection in UTI patients is uncommon but these cases of complicated UTIs demonstrate C. indologenes as a potential cause of UTI in hospitalised patients using invasive equipment like urinary catheters. As the organism was Multidrug-Resistant (MDR), appropriate antibiotic treatment and accurate identification can alleviate infection by this organism.

Novel In-built Design to Retain Detachable Cheek Plumpers in Complete Dentures: A Case Report

Rachapudi Venkata Roshini, K Vaishali

Aesthetics are of prime importance to people irrespective of age. Aging and loss of teeth have a significant influence on external facial aesthetics, resulting in sunken cheeks and undesirable facial appearance. Cheek plumper is a prosthesis used to support sunken cheeks, thus enhancing the aesthetics of a person. Hereby, the authors present a case of a 65-year-old male patient, who reported with the complaint of missing upper and lower teeth. Intraoral examination revealed completely edentulous maxillary and mandibular arches. Extraoral examination revealed sunken cheeks. The patient was concerned about his appearance and wanted treatment for it. The treatment plan was to fabricate a complete denture with detachable cheek plumpers. This novel technique offers a simple and effective way to re-establish the lost facial aesthetics. The technique was simple, easy to fabricate and had good patient satisfaction, compared to the other techniques and methods. Follow-up after 24 hours, three months and six months was scheduled and the patient was satisfied with the prosthesis.

Approach-oriented Physiotherapeutic Management of a Patient with Right Thalamic Bleed: A Case Report

Neha Rajesh Badwaik, Pallavi Harjpal, Ragini Dadgal

Rehabilitation is essential for stroke recovery. Professionals with experience in stroke rehabilitation from the different fields should make up a basic multidisciplinary stroke rehabilitation team. A stroke is the sudden loss of blood supply to the brain followed by a neurological deficit for more than 24 hours. A 42-year-old male patient presented with chief complaints of sudden weakness over one side of the body, slurred speech and blurred vision. The patient showed typical features of stroke-like tonal abnormalities, altered sensorium, diminished reflexes, reduced range of motion and strength. Magnetic Resonance Imaging (MRI) showed bleeding in the right lenticular capsular, basal ganglia and intraparenchymal part of the thalamus. The physiotherapy treatment started from the Intensive Care Unit (ICU) itself for better results with the collaboration with neurosurgeons and nurses, after the surgery. The Proprioceptive Neuromuscular Facilitation (PNF) approach and Rood’s approach were used to generate neuroplasticity as early as possible. The motor relearning program helped to regain the movements. Various outcome measures like the National Institute of Health Stroke Scale (NIHSS), Brunstorm grading, and Barthel index showed many crucial changes in tone, strength, balance, and coordination that improved the patient’s Quality of Life (QoL). Also, speech therapists and neuro-optometrist play an important role during rehabilitation.

Incidentally found Bilaterally Occult Femoral Hernia during Transabdominal Preperitoneal Inguinal Hernia Repair: A Case Report

Ajay Rajyaguru, Raj Bhupendra Depani, Sachin Singh, Hiral Chaudhary

Hernia is defined as an area of anatomical weakness or an abnormal protrusion of a viscous or a part of a viscous through an opening, covering it. Inguinal hernia is the most common hernia because of the presence of natural weakness like the deep ring and cord structures. The minimally invasive procedures for inguinal hernia repair include Intraperitoneal Onlay Mesh (IPOM) repair, Transabdominal Preperitoneal Repair (TAPP), and Total Extraperitoneal (TEP) repair. Laparoscopic inguinal hernia repair has the advantage of inspecting the entire myopectineal orifice, as it allows for the identification of bilateral or recurrent hernias. The principle behind laparoscopic repair includes strengthening of myopectineal orifice in all the above approaches. TAPP repair is mainly indicated for large indirect hernias or irreducible hernia. TEP repair is technically challenging to perform and has the advantage of avoiding interbowel adhesions as the peritoneum is not opened. IPOM repair is not routinely performed but has advantages in cases where there is an increased risk of spermatic cord injury seen in patients with a history of lower abdominal irradiation or a history of multiple recurrent hernia surgery. Occult contralateral inguinal hernia and the occult femoral hernia can be easily diagnosed and repaired with no extra incisions while performing TAPP repair. These hernias, if left untreated may present as recurrent hernias or as non resolution of symptoms posthernia surgery. A rare case of bilateral occult femoral hernia found during laparoscopic TAPP repair of an inguinal hernia was reported. The entire myopectineal orifice was repaired using the same mesh with no extra risk or cost.

Joubert Syndrome with Renal and Cerebral Manifestations: A Case Series of Three Siblings

Sushant Kumar, Ashok Bhat

Joubert syndrome is a rare genetic disorder. Marie Joubert made the first official diagnosis of the syndrome in 1969. It is characterised by aberrant neurodevelopment and a complex midbrain-hindbrain malformation which can be seen on the Magnetic Resonance Imaging (MRI) as molar tooth sign. The present case series reports three female siblings from a consanguineous marriage. The first child had delayed developmental milestones, ataxia, mental retardation and presented with advanced renal failure and succumbed to uremic complications. The second and third siblings also had similar clinical findings and the diagnosis of Joubert syndrome was confirmed by the presence of molar tooth sign on MRI. The presence of renal failure in them was detected earlier than the first sibling with favourable outcome in both. The characteristic symptoms of Joubert syndrome include developmental delay, intellectual disability, ocular abnormalities, and lack of control over voluntary movements. Each sibling of an affected individual has a 25% chance of developing the disease, a 50% chance of being an asymptomatic carrier, and a 25% chance of being not affected and not being a carrier. Renal involvement occurs in approximately one third of patients. In the present case series, all the siblings were affected by the syndrome and developed renal failure which is extremely rare. Failure to evaluate the renal function in these patients can result in delayed presentation with adverse outcome as seen in the first sibling. The case series highlights the importance of considering this disorder in the differential diagnosis of chronic kidney disease, especially in cases with a family history and other suggestive symptoms and the need for early recognition and management of the disorder, as early intervention and supportive care can improve the patient’s quality of life and prognosis.

Neonatal Scrub Typhus- A Series of Five Cases

K Vindhiya, A Priya Margaret, LL Prathyusha, S Ramitha Enakshi Kumar

Scrub typhus is a rickettsial infection caused by Orientia tsutsugamushi. This is transmitted by trombiculid mite called chiggers. A number of cases of scrub typhus are being reported from North India. However, there has been a steady increase in the number of cases from Southern India, especially Tamil Nadu, Kerala, and Karnataka. The manifestation of the disease is due to the vasculitis and perivasculitic involvement. This vasculitis is responsible for oedema, skin rash and end organ ischaemic injury. A skin lesion called eschar is pathognomic of this condition, which is present in 40% of the cases. It is a close differential diagnosis for other common infectious diseases like- dengue fever, malaria, enteric fever and severe sepsis. Scrub typhus is rare in neonates. Herewith, the authors reported five cases of neonatal scrub typhus with varied clinical manifestations. All the five neonates (two females and three males) had fever and high C-reactive Protein (CRP), two had hepatosplenomegaly, two presented with shock, one had paralytic ileus, one baby had features of aseptic meningitis and one had pericardial and pleural effusion. Two out of five babies had an eschar, which is pathognomonic of scrub typhus.Three babies were treated with Doxycycline and two babies required Intravenous (i.v.) Azithromycin. All of them recovered completely, except one baby, who succumbed to the illness. A high index of suspicion is required to diagnose scrub typhus in neonates early.Timely intervention will prevent morbidity and mortality.

Anaesthesia for Thoracic Aortic Disease: Series of Four Cases

S Ajanth, S Mano Praveen, Rameshwar A Mhamane, Charulata M Deshpapande

Thoracic aortic diseases involving the thoracic aorta, from the ascending aorta, the aortic arch to the descending aorta, can present in the form of aneurysms, dissection, tear and coarctation which usually lead to various complications, requiring surgical intervention. The same can be addressed surgically by ascending aorta replacement or reduction aortoplasty with/without Aortic Valve Replacement (AVR). The anaesthetic implications might vary depending on the pathology of the thoracic aortic disease which can be acute or chronic and, silent or symptomatic. Anaesthetic management of four patients (2 females and 2 males) with varied thoracic aortic diseases have been described in the series, including bicuspid aortic valve with severe aortic stenosis, Ischaemic Heart Disease (IHD) with severe Aortic Regurgitation (AR) with ascending aortic aneurysm, ascending aortic dilatation in a known Takayasu arteritis patient and coarctation of aorta with atrial septal defect. These patients underwent aortoplasty with or without aortic root replacement. Full cardiopulmonary bypass with Deep Hypothermic Circulatory Arrest (DHCA) at 16-20°C was the technique used for these procedures as it prevents stroke and ensures cognitive function. This technique had no additional cannulas, less chances of intimal injury or embolisation and clear surgical fields. During the process of rewarming, Inj. nitroglycerine was started which reduced preload, conserving the myocardium against ischaemic injuries. These patients were successfully managed perioperatively and were discharged with good outcomes postoperatively.

Variations in the Branching Pattern of Coeliac Trunk: A Cadaveric Case Series

During routine cadaveric dissection for students, the authors found variations in three cadavers. A male cadaver of approximately 70 years of age showed a unique branch communicating the coeliac trunk with the Superior Mesenteric Artery (SMA). The right and left hepatic arteries gave smaller branches before entering into liver. In another male cadaver of approximately 60 years of age, the left hepatic artery was arising from the left gastric artery. The common hepatic artery gave rise to right gastric artery and gastroduodenal artery, after which it continued as right hepatic artery proper. This gave rise to cystic artery. The present series also observed quadrifurcation of coeliac trunk in a male cadaver of 70 years of age. It gave off four branches namely, splenic artery, left gastric artery, right hepatic artery and left hepatic artery. The gastroduodenal artery was arising from the left hepatic artery. The variations in the branching pattern of coeliac trunk is important for the surgeons during gastric surgeries, liver transplantation, pancreatic and gall bladder surgeries. Radiologists should be aware of such variations during reporting of Computed Tomography (CT) angiograms.

Aberrant Cytomorphological Features of Primary Plasma Cell Leukaemia: A Case Series

Prithal Gangadhar, Lovely George, Sandhya Ilanthodi, Purnima S Rao

Primary Plasma Cell Leukaemia (pPCL) is a rare but distinctive sub-type of Plasma Cell Myeloma (PCM) comprising approximately 2-4% of cases of PCM and characterised by short remissions and survivals. Apart from these clinical distinctions, this entity also demonstrates unique cytomorphological features. The authors here attempted to highlight this unusual spectrum of leukaemic plasma cells, posing diagnostic challenges in the blood and bone marrow examinations. The cases presented in this series (48 years old male, 72 years old male,68 years old male and 63 years old female) patients, showed presence of atypical cells in the peripheral smear with few cells portraying the characteristic “hairy cell” morphology, the fourth case in addition, showed small sized plasma cells resembling lymphocytes. Bone marrow biopsy in three cases showed haematopoetic cells replaced by sheets of atypical plasma cells. In addition, the fourth case showed atypical cells having convoluted and notched nuclei giving a differential diagnosis of lymphoplasmacytic lymphoma and small B-cell lymphoma with plasmacytic differentiation. As plasma cell neoplasm was not suspected clinically in all four cases, flow cytometry was sought for confirmation which showed atypical cells expressing CD38 (+), CD138 (+), CD56 (–) with Cykappa (+) in first case, Cylambda (+) in the second case and Cykappa (+) in the fourth case with aberrant expression of cyclin D1 thus confirming a diagnosis of PCL in first two cases and PCM-lymphocytic type with PCL in the fourth case. Immunophenotyping was not performed in the third case due to financial constraints. This case series showcases this mélange of cytomorphological variations of plasma cells ranging from cells masquerading as hairy cells to small sized plasma cells resembling lymphocytes, each posing a unique diagnostic dilemma. This has been rarely discussed in prior published case series. Aberrant morphological features rarely seen in PCL, could lead the pathologist astray from the diagnosis, therefore appropriate use of ancillary tests are essential to arrive at a correct diagnosis.

Anaesthesia for Thoracic Aortic Disease: Series of Four Cases

S Ajanth, S Mano Praveen, Rameshwar A Mhamane, Charulata M Deshpande

Thoracic aortic diseases involving the thoracic aorta, from the ascending aorta, the aortic arch to the descending aorta, can present in the form of aneurysms, dissection, tear and coarctation which usually lead to various complications, requiring surgical intervention. The same can be addressed surgically by ascending aorta replacement or reduction aortoplasty with/without Aortic Valve Replacement (AVR). The anaesthetic implications might vary depending on the pathology of the thoracic aortic disease which can be acute or chronic and, silent or symptomatic. Anaesthetic management of four patients (1 female and 3 males) with varied thoracic aortic diseases have been described in the series, including bicuspid aortic valve with severe aortic stenosis, Ischaemic Heart Disease (IHD) with severe Aortic Regurgitation (AR) with ascending aortic aneurysm, ascending aortic dilatation in a known Takayasu arteritis patient and coarctation of aorta with atrial septal defect. These patients underwent aortoplasty with or without aortic root replacement. Full cardiopulmonary bypass with Deep Hypothermic Circulatory Arrest (DHCA) at 16-20°C was the technique used for these procedures as it prevents stroke and ensures cognitive function. This technique had no additional cannulas, less chances of intimal injury or embolisation and clear surgical fields. During the process of rewarming, Inj. Nitroglycerine was started which reduced preload, conserving the myocardium against ischaemic injuries. These patients were successfully managed perioperatively and were discharged with good outcomes postoperatively.

Dental Distraction Goggles: An innovation

Preethi Murali, Manoj Prabhakar, Logeswari Jayamani, B Kavitha

Patients who are undergoing dental procedures develop emotions which depend mostly on the nervous and endocrinal systems. It can be illustrious in between physiological changes, behavioural, bodily movements and facial expressions of the patient. Source of consciousness augment the fight or flight response. Dental procedures cause quite an anxiety i.e., emotions similar to fear but arise with a source that are unrecognised. Therefore, it is a problematical occurrence for both patients and dentist (1). The substantial fraction of first dental visit may obstinate the patient who are not aware of the instructions given by the dentist causing difficulty to grasp the oral hygiene practices and therefore, establish the poor oral hygiene (2). The occurrence of anxiety takes place by means of seeing the dental chair set-up and the sounds caused by the equipment or the machinery. Usually, every patient prefers a comfortable, calm and soothing environment during dental treatment procedures on a dental chair. Hence, an innovation is made as an eyewear with a removable disc exhibiting pictures/images in it to circumvent anxiety and engross the patient from fear of the treatment procedure, thereby distracting the patient from anxiety during the dental procedure (3). Distraction technique is most successful and effective technique among the patients for reduction in dental anxiety. It diverts the patient’s attention from the treatment process (3). It is not only a successful and effective technique, but recent dental studies have shown that distraction is most commonly used technique to create positive behaviour, thereby altering the perception of pain and responses to the dental procedures (4),(5),(6). Distraction technique is in general classified into active distraction and passive distraction techniques (5),(7). In paediatric patients, active distraction technique promotes the child’s interest during the dental treatment which includes singing, playing toys, squeezing balls and so on. Passive distraction technique requires the child to be quiet and calm during the dental procedure (5). The difference between fear and anxiety is contentious and many times it is considered to be same. Nevertheless, it has been confirmed that, if stimulus is known then it is fear and when it is unknown, then it is known be anxiety (7). The effectiveness and outcome of the treatment in paediatric patients is greatly dependent on the patient’s behaviour and cooperation. Use of distraction methods during the treatment have gained popularity and proved effective. The present paper has reviewed one such patented distraction goggles number 202241017726A and its utility in anxiety management. Description of the Eyewear The enhanced advantage of protective eyewear is to prevent the patient from visualising both the operative procedures and instrumentations (i.e., syringes and needles) used by doctors/dentists at the clinic set-up and replace it with pleasant images. Dental distraction goggles is a patented device and first of its kind and have not been used, so far. The eyewear has a removable disc with pictures in it used to distract a patient from the dental treatment procedure. There may be six or more pictures that depict a choice of visuals representing positivity. A lever is attached to the eyewear which can be clicked by the patient himself or the dental assistant to change to the next picture during the treatment procedure. The lever in the goggles simply acts with up and down mechanism on the disc, which has slots to hold the lever extension, when pictures are changed. The dental distraction goggles of the present invention comprises of goggles frame to extend around two eyes and between the wearer’s temples to fit against wearer’s face, characterised with provision of disc insertion slots on both lens rims of the goggles frame (Table/Fig 1). The disc insertion slot is configured at the rim of the googles to receive a removable disc and coupled with a spring and a lever. The disc comprises of alternative slots and photo sheets exhibiting pictures circumferentially (Table/Fig 2). The lever is configured to work by up and down mechanism accordingly actuating the spring to rotate the disc with slots for changing pictures upon clicking (Table/Fig 3). The cardboard disc has four or more pair of pictures that can be advanced by rotation using a lever or button. The reclining position of the patient enables the dental unit light to disperse on the pictures allowing the patient to visualise. The slots in the disc rotate permitting the advancement as the lever/button is clicked. A spring attached on the other side of the disc to hold, as well enable rotation of the disc intermittently. This eyewear would be highly helpful visual distractor for the patient who may either be a child or an adult. Various studies have proved the patient cooperation gets better when they are distracted from actual procedures [5,7-9]. The dental unit uses either halogen light or light emitting diode, either of which is a demanding light source for accurate visualisation, but unfortunately this is a main anxiety producing element for paediatric, as well as, adult patients. These distraction googles can eliminate the exposure to these light by acting as a visual distractor and there by decrease the patient’s anxiety and enhance their level of cooperation. This technique is easily acceptable, owing to its simple design. However, it can hamper eye communication between dentist and the patient, which can be critical. Nonetheless, it can be managed by verbally communicating. For any dentist, the main desire is to treat their patient anxiety free, at the same time providing the best quality dental care (8). Thus, distraction goggles may serve as an effective and economical visual distractor, owing to its simple design and accessibility.

A Rare Case of Extracranial Meningioma of the Temporal Bone

A 54-year-old female patient came with complaints of progressively increasing swelling over the forehead and temporal region on the right side for two years. The swelling was painless and was associated with proptosis. The swelling was not associated with loss of vision. A plain computed tomography scan of the brain revealed a large predominantly extracranial soft tissue density lesion approximately measuring 5.2×4.1×5.7 cm, which was located in the right temporal region and was seen to be extending into the infratemporal fossa (Table/Fig 1). The intracranial extension of the tumour was noted along the anterior aspect of the temporal bone on the right side. The lesion was also seen to be extending into the right orbital space pushing the lateral rectus muscle and optic nerve medially. The lesion eroded the temporal bone, greater wing of the sphenoid bone, and lateral wall of orbit on the right-side (Table/Fig 2). Magnetic Resonance Imaging (MRI) brain with contrast revealed the same extensions as that of Computed Tomography (CT). The lesion involved the temporalis muscle and showed heterogenous enhancement in postcontrast study (Table/Fig 3). There was no evidence of local lymphadenopathy. The patient underwent near total excision of the lesion and the tissue was sent for histopathological examination. The histopathologic features revealed meningothelial meningioma arising from the temporal bone with a predominant extracranial extension which was suggestive of extracranial meningothelial meningioma (Table/Fig 4).

Goitre-A Clinical Image

Aman Chhabra, Vaishali Kuchewar, Twinkle Joshi

Goitres are clinically discernible thyroid gland enlargements defined by uncontrollable growth and structural and/or functional alteration of one or more regions inside the normal thyroid tissue. They form an entity known as simple nodular goitre when dysregulation, thyroiditis, autoimmune thyroid disease, and thyroid cancer are absent (1). This is regularly observed in nations without a public health initiative to prevent iodine deficiency (2).The case is relevant as it signifies a rare clinical condition which in future causes systemic complications. Furthermore, even when the gland is normal to palpate, upto 50% of the general population has thyroid nodules on sonography (3),(4),(5). This could be one of the reasons for the rising use of diagnostic imaging in the evaluation of such patients, in addition to functional characterisation with blood Thyroid Stimulating Hormone (TSH), at least among thyroidologists (6),(7),(8),(9). It is noticed as a palpable or obvious swelling of the gland near the base of the neck. It could be associated with hypothyroidism, hyperthyroidism, or euthyroidism (10). The symptoms are linked to adrenergic stimulation. Clinical signs and symptoms frequently involve hypermetabolism (increased metabolism), excessive thyroid hormone, a rise in oxygen consumption, alterations in protein metabolism, immunologic stimulation of widespread goitre, and ocular abnormalities. However, the non-specific nature of these symptoms makes diagnosis challenging. A 72-year-old male patient came to the outpatient department with the complaints of a diffused swelling over the throat region.The patient noticed the swelling three months back, which was increasing gradually. The swelling was associated with minor pain while speaking and swallowing. On clinical examination, lymphadenopathy was noticed at cervical lymph nodes of size 4 cm in length and 5 cm in width at front side of neck region. The overlying skin was not movable and was non-tender during palpation. On laboratory examination, only the thyroid profile was done by the patient, which was within normal limits. It was thus, diagnosed to be a non toxic goitre. Since, the swelling was diffused and large, a surgical excision was advised. After the surgical excision of the nodular goitre, the swelling was relieved and patient was free from any symptoms with a significant reduction in the size of the nodule. These images could be useful for differential diagnosis with anaplastic thyroid carcinoma, carotid artery aneurysm, and subacute thyroiditis (Table/Fig 1),(Table/Fig 2). Similar outcomes were seen in later investigations, which demonstrated a goitre size decrease of 40% to 60% within 1-2 years of medication (11),(12),(13). The 131I technique is easy, affordable and secure. After a single dosage of 131I, it is expected that thyroid volume decrease to 40% (total as well as nodule volume) and a cure rate of 75% (normalisation of scintigraphy and serum TSH) will occur (Table/Fig 3) (11),(12),(13),(14),(15),(16),(17),(18),(19). Similar findings have been made for toxic solitary thyroid nodules (21),(22). The minor side effects include hypothyroidism, which is unrelated to any kind of dose planning. Patients who additionally have thyroid autoimmune disease or prolonged absorption by extranodular thyroid tissue are more likely to have hypothyroidism (23).

Low Prevalence of Mumps IgG Antibodies among the Paediatric Population Attending Tertiary Care Hospital in Southern India- A Pilot Study

Aridass Dhanasezhian, Murugesan Amudhan, G Sucila Thangam

Dear Editor, Mumps is a Vaccine-Preventable Disease (VPD) that can cause self-limiting parotid glands swelling to complicated meningitis, deafness, and infertility. In India, Mumps vaccine is not included in the universal immunisation program; hence sporadic outbreaks and incidents have occurred around the country. In this pilot study, it was revealed that the prevalence of IgG antibodies against the Mumps virus was significantly (p<0.001) lower than the Measles and Rubella viruses. Thus, we suggest the nation wide antibody prevalence study to unravel the protective IgG level and to incorporate the mumps component in the universal immunisation schedule. Mumps is a vaccine preventable disease and an efficacious safe vaccine is available, which was integrated in routine immunisation schedule in 121 (62%) countries in the form of the Measles, Mumps and Rubella (MMR) vaccine. In India, Mumps is not viewed seriously due to the lack of sufficient published data and also this disease is considered to be self-limiting [1,2]. The Indian Academy of Paediatrics (IAP) has regarded the burden of Mumps and the same logistics can take care of these three Vaccine Preventable Disease (VPDs) instead of two, hence the association strongly recommended the inclusion of Mumps component in the MR vaccine (3). Considering the facts above, a pilot study was conducted for estimating the IgG antibodies against the MMR viruses among the paediatric population. This study was a single-centre pilot study done during the period of December 2018 to November-2019. After obtaining institutional ethical clearance (Ref No: 2544/ME1/18 Dated: 07.06.2018), a total of 124 anonymous serum samples were collected from children aged between 3-12 years and included in the present study. Among them, 65 and 59 were males and females, respectively. Through the peripheral vein puncture, 3 mL of blood were collected in the clot activator tube. The blood were mixed by inverting the tube 5 times and was left at room temperature for 30 minutes. Subsequently, the serum was separated using centrifugation at 1500 rpm for 10 minutes. Serum samples were stored in 2 mL storage vials at -20°C deep freezer until further analysis. MMR IgG antibodies were tested by the ELISA (Calbiotech IgG ELISA kit, USA), as described by the manufacturer. The test for one proportion was used to test the hypothesis that an observed proportion is equal to a pre-specified proportion using the MedCalc web tool (4). The Mumps virus is highly contagious and has a very high secondary attack rate (5). Data and studies pertinent to Mumps virus infection and seroprevalence were scanty. Gupta R et al., observed a significantly decreased seroprevalence of Mumps IgG among the children in Rajasthan (6). In this study, out of 124 samples tested, 107 (86.3%), 45 (36.3%) and 88 (71%) were positive for MMR IgG antibodies, respectively. The Mumps IgG antibodies were significantly (p<0.001) lower than Measles and Rubella (Table/Fig 1). This study revealed that the protective antibodies against the Mumps virus were minimal compared to the other two viruses. The clinical spectrum of the mumps infection ranging from self-limiting parotid glands swelling to severe complications such as encephalitis, meningitis, orchitis, myocarditis, pancreatitis, and nephritis (7). In 2015, Raut CG et al., reported Mumps outbreak in Karnataka (8), Chauhan P et al., reported the outbreak in 2018 at a naval training establishment in Andhra Pradesh (9); and the Integrated Disease Surveillance Programme (IDSP) has reported 45 outbreaks of mumps in different parts of the nation (2). Sporadic cases were also reported throughout the country. Considering the clinical spectrum of the disease, incidence and prevalence, there is an urgent need to incorporate the mumps component in the Indian immunisation schedule, which could prevent the larger outbreaks and associated morbidity and mortalities. A study conducted by Malaiyan J and Menon T showed the occurrence of Mumps infection among the MMR vaccinated individuals due to the discrepancy between the vaccine strain and the strains which were circulated in the reported region (10). Hence, there is unmet need to conduct nation wide MMR vaccine efficacy studies and reconsider the Mumps component used for the vaccine production.

Severe Acute Necrotising Pancreatitis Presenting as Pancreaticocutaneous Fistula: A Rare Complication

Dear Editor, Pancreatic glandular necrosis is the most common contributor to severe acute pancreatitis. When necrosis is present, the mortality and morbidity that come with acute pancreatitis are significantly higher, with associated infection in the necrotic area. Pancreatic fistulas generated by a ruptured pancreatic duct can develop following the surgery. In 15-23% of instances, pancreatic fistulas aggravate necrotising pancreatitis (1). Treatment can range from early surgical debridement (necrosectomy) to aggressive intensive medical care (2). This letter is about a 36-year-old male, who came to the casualty with complaints of pain in abdomen radiating to his back and associated with distension of abdomen, nausea and 8-10 episodes of vomiting since five days. The patient was a chronic alcoholic. There were no other co-morbidities. He was admitted to the Intensive Medical Care Unit. On physical examination, the patient was afebrile, tachycardia was present, and abdomen was tender. Investigations revealed serum amylase to be 800 U/L, serum lipase 1400 U/L, total leucocyte count 12.2×109/L, platelets 1.62 lac, and serum calcium 6 mg/dL. Ultrasonography (abdomen and pelvis) was suggestive of acute pancreatitis, hepatomegaly with grade II fatty liver, and mild splenomegaly. The patient was kept nil by mouth and was started on fluid resuscitation, injection meropenum 1 gm i/v thrice a day, injectable metronidazole 100 mL thrice a day, injection tramadol 100 mL i.v. thrice a day, pancreatin minimicrospheres capsules 25000-10000-10000 IU thrice a day, multivitamin with L-Methionine, and selenium yeast tablets twice a day. Contrast-enhanced CT abdomen revealed bulky pancreas throughout its course and peri-pancreatic fat stranding and fluid collection abutting lesser curvature of stomach suggestive of acute pancreatitis with necrotic collection, modified CT severity index score was 10. Interventional radiologist’s opinion was taken in view of necrotic collection. An USG-guided catheter was inserted, and 300 mL output was obtained in five days. The drain was removed when there was less than 20 mL output per day. The patient developed anterior abdominal wall swelling within three days after the drain was removed (Table/Fig 1). Local examination revealed pus draining through the catheter insertion site along with anterior abdominal wall swelling (Table/Fig 2). As the abdominal distension increased CECT abdomen was repeated. It revealed acute pancreatitis with necrotic collection in subcutaneous and intramuscular plane of anterior abdominal wall, in the left hypochondriac and supra umbilical region communicating through a tract (Table/Fig 3). The patient was planned for incision and drainage and 50 cc of necrotic material was drained (Table/Fig 4). He was discharged after three days and is awaiting for follow-up after one month. This case reports an uncommon complication that happened during the treatment of a reasonably frequent acute surgical illness. Enteroatmospheric fistulas are known to have a notably higher fatality rate than their analogue, enterocutaneous fistulas (3),(4),(5). Pancreaticoatmospheric fistulas may present in similar pattern and is associated with high mortality (28.6%) (3). When compared to primary open necrosectomy, the Patients with Acute Necrotising Pancreatitis (PANTER) study found that the minimally invasive stepup method lowered the rate of complications and mortality. In this way, more than one-third of patients were effectively treated with percutaneous drainage only (6). Management of severe acute necrotising pancreatitis necessitate multidisciplinary approaches, including resuscitative and supportive measures, as well as, prompt management of fistula drainage for optimal wound management with eventual wound coverage and fistula closure.

Hapticophagia in Iron Deficiency Anaemia and Oral Submucous Fibrosis- Two Sides of the Same Coin

P Poornachitra, Arvind Muthukrishnan

Dear Editor, Oral Submucous Fibrosis (OSF) is a well recognised Oral Potentially Malignant Disorders (OPMD) that is primarily attributed to areca nut chewing in raw form or commercial preparations. Areca nut is also an independent risk factor for developing oral cancer. The worldwide rate of malignant transformation from OSF is 2.3%-7.6%; in India, the potential malignant transformation rate is 7% to 30% (1). Arecanut is a psychoactive substance whose alkaloids (arecoline, arecaidine, guvacoline, and guvacine) modulate the autonomic nervous system by transiently amplifying sympathetic activity and gradually reducing vagal action (2). Among nitrosamines produced by alkaloids in the oral cavity, methylnitrosaminoproprionitrile is the most carcinogenic (3). The lesser known factors in the commencement of the chewing habit in rural areas are its usage in local indigenous native medicine which eventually creates dependency over a period of time. Areca nut is used as remedies for halitosis and digestive disorders and as a deworming agent (4). In rural areas of India, Areca nut and betel leaves are used to cure indigestion during pregnancy and combat postpartum depression (5). Recent ethnopharmacological studies have discovered that the hydroalcoholic extract from areca nut inhibits bradykinin which induces extravasation of plasma proteins in dura mater [6,7]. This property might possibly be a reason for being used as a remedy for migraine attacks. The physiology of craving to fathom the dependence on areca nut chewing must be understood. The food cravings originate in the hippocampus, the memory center, and nucleus accumbens, the pleasure centre, are an interplay of an imbalance of neuropeptides such as dopamine, serotonin, and leptin with endorphins released after chewing the craved item which mirrors the pathway of addiction [8,9]. Interestingly, in Iron Deficiency Anaemia (IDA), there do exist cravings for pica (allotriophagia), corn starch (amylophagia), and ice (pagophagia) which have been well-documented. Hapticophagia or tactile chewing cravings is now a recognised phenomenon observed in IDA wherein, the individuals crave for mastication of hard items to repeal the neurocognitive effects of deficient dopamine and excess Monoamine Oxidase (MAO) (10) that gets corrected with iron repletion. Dopamine modulates sleep, mood, attention, behaviour, motivation, and working memory and MAO is responsible for the disintegration of dopamine, norepinephrine, and serotonin (11). World Health Organisation (WHO) has declared anaemia as a global health problem with nutritional deficiency. Recent evidence recommends that serum iron and haemoglobin assessment should be done in OSF patients during initial diagnosis and treated simultaneously if deficiency prevails [12,13]. Pica or allotriophagia (14), the craving and compulsive consumption of non food substances, and desiderosmia (15), the olfactory cravings are established manifestations of IDA that get cured with iron replacement therapy. Hapticophagia or tactile chewing cravings is now a proposed symptom with IDA that includes a variety of items namely ginseng, pickles, sawdust, chips, popcorn, crackers, chewing gum, and dry oats (15). Hence, it could be credent to also consider IDA as one of the predisposing factors for incipience of areca nut chewing. It is, therefore, necessary to broaden the tunnelled vision to the fact that malnutrition in individuals of low socio-economic groups that precipitates IDA may initiate hapticophagia and areca nut becomes an easily accessible product among their fraternity to feed their cravings in occupations like drivers and migrant workers. Hence, it must be mandatory for areca nut chewers irrespective of clinical presentation, to be screened for IDA and the findings must be taken into the equation in formulating habit cessation strategies as a personalised recuperative approach. For arriving at the diagnosis of IDA, the American Society of Haematology (ASH) and the British Society of Haematology (BSH) (16) and the BSH (17) recommend the Complete Blood Count (CBC) or Full Blood Count (FBC). Also, understanding the pathophysiology of IDA in men is still nascent, which needs to be explored as areca nut chewers have a male predilection. The current rehabilitation protocols are structured based on a limited behavioural understanding of the chewers and hence, consuming arecanut after a period of cessation is quite common. Future research pursuits should focus on devising non pharmacological rehabilitation methods among addicts of areca nut beyond conventional counselling or drug therapy. The hapticophagia mechanism can be configured with alternative hard chewable items like ice chips or hard candies that can trigger the common neural circuitry of the reward system. This intervention will motivate them to the path of recovery as an adjunct in assisted habit cessation protocol. These chewable replacements should be edible and be fortified with iron as a micronutrient powder in standardised commercial preparations as a supportive supplementation, if IDA management is also required. This tactile chewing on healthy food derivatives not only combats micronutrient deficiency but also, plummets areca nut cravings with rejuvenated homeostasis, leading to the prevention of OSF and its progression to oral squamous cell carcinoma.

Efficacy of Vaginal Misoprostol Administered for Rapid Management of First Trimester Spontaneous Onset Incomplete Abortion in Comparison to Manual Vacuum Aspiration: A Randomised Clinical Trial

Tuhin Subhra Roy, Pradip Kumar Saha, Sangeeta Roy

Introduction: Both, surgical and medicinal techniques can be used vaginally to treat incomplete abortions. Although, Manual Vacuum Aspiration (MVA) is a safe and efficient surgical treatment for the management of incomplete abortion, it is not frequently offered and is not very cost effective in rural areas, especially in low resource settings. Misoprostol is an alternative to MVA for the treatment of incomplete abortion. Aim: To assess the effectiveness and acceptability of using vaginal misoprostol for the management of first trimester spontaneous incomplete abortion as an alternative to MVA. Materials and Methods: A randomised clinical trial was conducted between February 2020 to July 2021 in the Department of Obstetrics and Gynaecology, at RG Kar Medical College and Hospital, Kolkata, West Bengal, India. A total of 144 participants were randomised into two groups with 72 women in each group, to treatment with either MVA or 400 mcg vaginal at 3 hour intervals. The main outcome measures assessed at 24 hour follow-up were complete uterine evacuation confirmed by transvaginal sonography, and client acceptability and satisfaction were assessed from entry in data form by participants. Chi-square (χ2) tests were used for categorical data, and the Student’s paired t-test was used for continuous data. Statistical significance in all calculations was defined as p<0.05 and the study would follow the Intention To Treat (ITT) analysis while computing the results. Results: The mean ages were 27.44 years (6.8) and 28.47 years (6.6) for the misoprostol and MVA groups respectively. For the gestational age, the mean gestational ages were 8.88 (2.01) and 8.90 (2.17) weeks for the misoprostol and MVA groups, respectively. A higher failure rate in terms of incomplete abortion was encountered in the misoprostol arm compared to the MVA arm. Although this difference in complete uterine evacuation rate did not reach statistical significance (RR=4, 95% Confidence Interval (CI) 0.879-18.192, p=0.0728). Pyrexia appeared to be a significant complication in the misoprostol group compared to MVA group (p=0.038). There was no significant difference in satisfaction in both groups (p=0.659) and no significant difference in acceptability. Conclusion: As an alternative to surgical intervention, three 400 mcg misoprostol pills could be administered vaginally over the course of three hours to treat spontaneous first trimester uncomplicated incomplete abortion.

A Scientometric Analysis of Scholarly Literature on Radiological Sciences from Saudi Arabia over the Last Thirty Five Years (1985-2020)

Ali Aldhebaib, Fayazul Haq, Oinam Gokulchandra Singh, Ikram UL Haq

Introduction: Scientometric analysis helps to measure the research growth and highlights the salient characteristics of the specific dataset. Saudi Arabia is rapidly growing country in the field of science and technology and remarkably contributing in the research productivity in all areas of health sciences, including radiological sciences from 1995 to 2000 and is drastically increased globally. Aim: To analyse the credible literature on radiological sciences research from Saudi Arabia as reflected in the Scopus database. Materials and Methods: This was a quantitative exploratory study based on scientometric analysis. The data was extracted from the Scopus database. The subject category of “radiology, nuclear medicine and imaging” was selected in the advanced search feature of the Scopus database. All the relevant scholarly literature consisted of articles and reviews indexed under the country name of Saudi Arabia published in English language from 1985 to 2020 were included for analysis. Results: Saudi Arabia was ranked 33rd with 1,587 papers in radiological sciences, representing 0.43% of the global share. The slow progress was observed in the first 20 years but the remarkable growth was recorded during the last five years of study. King Saud University and King Faisal Specialist Hospital and Research Centre were the most contributing institutions. Saudi radiologists collaborated with 99 countries of the world and the United States was on the top. Four national journals were included in the list of top 10 preferred journals. Conclusion: Although the rising tendency in radiological sciences research was evident during the last 10 years, still the share of Saudi Arabia was found much lower in comparison with the developed countries. Few well-established Institutions have taken lead in research productivity but a prioritised response from other Research Institutions is recommended.

Chimerism Revisited: Perspective of an Immunopathologist

Devika Gupta, Lavan Singh, Kamlesh Kumar Singh, Tathagata Chatterjee

Introduction: Chimerism analysis is an important diagnostic tool not only for assessing the risk of relapse after allo-Haematopoietic Stem Cell Transplant (HSCT) in patients with malignant diseases, it is also the predominant method for monitoring post-transplant engraftment status in both haematological malignancies and non malignant haematological disorders. Aim: To show the chimerism data observed in post-HSCT cases of the hospital over last four years and to emphasise on timely and close monitoring of these patients in the laboratory. Materials and Methods: The present study was a retrospective study in which 40 HSCT cases comprising of both haematological malignancies and non malignant haematological disorders were monitored in the molecular laboratory of Army Hospital (Research and Referral), at regular intervals by Short Tandem Repeats-Polymerase Chain Reaction (STR-PCR) for quantification of donor chimerism. The pretransplant workup included Human Leukocyte Antigens (HLA) typing of all recipients and donors, serum Panel Reactive Antibody (PRA) testing and Single Antigen Bead (SAB) assays for detecting donor specific antibodies in all haploidentical transplants. Results: Male patients formed majority, with only nine female cases. After complete HLA matching and preconditioning, 35 patients underwent matched related stem cell transplant, two were Matched Unrelated Donor (MUD) and three haploidentical transplants. Complete donor chimerism at D+90 was reported in 19 patients (73%) of haematologic malignancies with two cases of relapse and five showing evidence of Graft Versus Host Disease (GVHD). Amongst non malignant disorders 10 patients (71.4%) showed complete donor chimerism at D+90 with two cases of GVHD. Conclusion: Post-HSCT, progressive chimerism monitoring is an essential molecular test that predicts engraftment status of the patient by verifying the dynamic relationship between recipient and donor cells.

Angiogenic Biomarker Placental Growth Factor (PLGF) in the Prediction and Diagnosis of Placental Dysfunction in Pre-eclampsia: A Cohort Study

Mandeep Kaur, Sahiba Kukreja, Namrata Chhabra, Ishaan Batish, Sangeeta Pahwa

Introduction: Pre-eclampsia (PE), a pregnancy induced hypertensive disorder affects approximately 8-10% of all pregnancies in developing countries. A highly sensitive and specific marker for diagnosis of PE is the need of the hour, as diagnostic criteria are still based on non-specific clinical symptoms, ultrasound, and laboratory findings. Imbalance in the placental release of various angiogenesis regulatory factors to the maternal circulation is one of the significant contributors to its clinical manifestations. Low levels of pro-angiogenic biomarker Placental Growth Factor (PLGF) are detectable several weeks before clinical presentation of PE. Aim: To determine the association of serum levels of PLGF with PE in second and third trimester of pregnancy. Materials and Methods: A prospective cohort study was performed in the Department of Biochemistry, in collaboration with the Department of Obstetrics and Gynaecology at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India, from December 2018 to November 2021. A total of 130 patients were selected and divided into two groups, pre-eclamptic cases, normotensive controls. At enrolment in second trimester (24-28 weeks) and during third trimester (beyond 28 weeks) serum PLGF concentration was measured by using the Enzyme-linked Immunosorbent Assay (ELISA) kit method. Data was statistically analysed. Student’s t-test was used for comparing differences between study groups. The Chi-square test was used to compare qualitative categorical data. Evaluation of the Area Under the Curve (AUC), diagnostic accuracy, sensitivity and specificity was done by Receiver Operating Characteristics (ROC) curve analysis done using software defined cut-off values. Results: A total of 115 patients were analysed in the present study with 55 patients in group 1 (mean age: 25.83±3.27 years) and 60 patients in group 2 (mean age: 30.52±5.63 years) When compared with normotensive group PLGF levels were significantly lower in pre-eclamptic group with median 16.27 ng/mL versus 12.20 ng/mL (p<0.001) in second and 14.05 ng/mL versus 10.50 ng/mL (p<0.001) in third trimesters respectively. ROC curve analysis using cut-off point of 14.91 ng/mL showed sensitivity 80%, specificity 96.7%, AUC 0.896, 95% CI: (0.832-0.959) in second trimester and in third trimester at cut-off point of 13 ng/mL sensitivity 73%, specificity 96.7%, AUC 0.882 95% CI: (0.816-.948) was found. Conclusion: PLGF may be used as a biomarker for early prediction, diagnosis, and management of PE. It might serve as ideal discriminating biochemical markers of PE. In the near future, the clinical utility of disease specific angiogenic biomarker in early detection of PE might improve health outcomes by preventing adverse maternal and neonatal outcomes and serious complications.

Association between Sociodemographic Factors and Severity of Psychiatric Symptoms with Duration of Untreated Psychosis in Patients with First Episode Psychosis: A Cross-sectional Study

Introduction: The Duration of Untreated Psychosis (DUP) is the time interval between the manifestation of the first psychotic symptom in a patient and the starting of proper treatment. Though, considered as a modifiable factor in the outcome of mental illness, many confounding variables such as sociodemographic factors and illness related factors can affect the DUP. Aim: To identify the association between sociodemographic factors and the severity of psychiatric symptoms with the DUP in patients with the first episode of psychosis. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Psychiatry, Government Medical College, Kottayam, Kerala, India, from March 2018 to February 2019. The first 50 consecutive patients reporting for treatment for the first time, who were diagnosed with psychotic disorders were recruited into the study. Details of the onset of psychosis were collected from the relative based on a clear, unequivocal description of symptoms by the relative. A specially designed proforma was used to gather the sociodemographic details and Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of psychotic symptoms. Statistical analysis was done using independent Student’s t-test, one-way Analysis of Variance (ANOVA) and Pearson’s correlation and p-value <0.05 is considered significant. Results: The mean age of the participants was 30.46 years and males constituted 31 (62%) of the participants. A total of 32 (64%) of the participants were unmarried or married but living separately. The mean DUP was 24.3 weeks (SD=23.9 weeks) and the mean BPRS score of the participants was 57.4 (SD=10.1). Schizophrenia was the diagnosis in 28 (56%) of the participants. There was a significant correlation between the DUP and BPRS with a p-value=0.021 and Pearson’s correlation coefficient of 0.326. A significant association was found between the BPRS scores and the psychiatric diagnosis, with schizophrenia having higher mean BPRS scores. Conclusion: The DUP is considered a modifiable factor in the outcome of psychotic disorders. Many factors affect the time interval between the manifestation of initial symptoms in a patient and starting of the proper treatment. A significant association was found between the DUP and the severity of psychotic symptoms as evidenced by the BPRS score.

Identification and Characterisation of Salmonella spp. Isolated from Stool Samples of a Food Poisoning Outbreak in Chite, Mizoram, India due to Consumption of Bekang-Um (Fermented Soybean)

Introduction: Traditional fermented soybean (“bekang-um”) is widely consumed by the indigenous Mizo tribe in Mizoram and plays a significant part of the local staple food. They are commonly prepared with herbs like culantro and often with just locally dried chilli flakes, implying it is mostly consumed raw without further cooking. Though it plays a staple part of the diet because of its unique taste, awareness on proper and regulated hygienic conditions during its preparation and fermentation processes is quite negligent. The fermentation process often warrants for the growth of not only commensal lactic acid fermenter bacteria like Acinetobacter spp., Lactobacillus spp., but also provides ample growth conditions for harmful bacteria like Salmonella spp., Clostridium spp., Intestinal Pathogenic E.Coli (IPEC) and Bacillus cereus. Aim: Phenotypic and molecular characterisation of Salmonella spp. isolated from the fermented food product bekang-um. Materials and Methods: The cross-sectional study was conducted within three months (October to December, 2020) in Multidisciplinary Research Unit (MRU), Zoram Medical College in collaboration with the Department of Veterinary Microbiology, CVSc and AH, Central Agricultural University, Selesih, Mizoram. A total of 18 stool samples were collected from patients (living in Chite, a small locality in Aizawl) who were still exhibiting symptoms of food poisoning (diarrhoea, vomiting and nausea) after consumption of fermented soybean all bought from their local neighbourhood fermenter and seller of the food item. The data was tabulated and statistically analysed using Microsoft excel and sensitivity/resistance patterns were expressed in percentages. Results: Salmonella spp. was isolated from 17 out of 18 stool samples collected. Out of 17 samples, 15 exhibited Multi-Drug Resistance (MDR) phenotypically to clinically relevant and widely used antibiotics like cefotaxime, ceftriaxone, ciprofloxacin, amoxicillin-clavulanic acid. Alarmingly, resistance genes like blaCTX-M1 (70.6%), blaCTX-M2 (35.3%), blaSHV (70.6%), blaTEM (52.9%), blaNDM (5.8%), blaAmpC (100%), blaKPC (29.4%), blaVIM (23.5%), blaIMP (11.8%) were commonly detected. Moreover, Salmonella virulence determinants like invA (41.2%), stn (41.2%), and biofilm-associated virulence genes like csgA (11.8%), csgD (70.6%) and adrA (5.9%) were also identified. Conclusion: The identification and characterisation of Salmonella spp. isolated from a widely consumed food product “bekang-um” (fermented soybean) with co-occurring crucial virulence, biofilm-producing and resistance gene determinants is quite alarming. The findings suggest the urgent need of implementing food safety conditions and proper preparation standards of the exotic food item, and the seriousness of the potential threat it can cause in cases of unhygienic fermentation processes.

Attention Deficit Hyperactivity Disorder and Use of Mobile Phones among Children- Need for Concern?

Aby Dany Varghese, Geethu Mathew, Cinderella Xson

Introduction: The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) is on the rise. Among multiple factors that are linked with ADHD, electronic media use has been gaining considerable attention recently. There is only a limited source of information regarding the burden of ADHD and its association with screen time in the Indian context. Aim: Screening of the children for ADHD and its association with mobile phone use at an outpatient service in a tertiary care hospital in Kerala. Materials and Methods: A cross-sectional questionnaire-based study was conducted among 157 children in the outpatient services in a tertiary care hospital in Pathanamthitta district, Kerala, India. School-going children aged between 6 and 11 years were included in the study. ADHD screening was done using Conner’s Abbreviated Rating Scale (CARS). Results: The mean age of children was 8.1±1.9 years. All the participants used mobile phones, and 15 (9.6%) owned one. The mean duration of mobile phone use per day was 1.4±0.7 hours. Among participants, 53 (33.8%) used mobile phones for more than one hour daily. Parents reported that nearly one-fifth of the children use mobile phones late at night (after 10 pm). Among children, 22.9% screened positive for ADHD. The ADHD scores are significantly correlated with the duration of mobile phone use (r=0.368 p<0.001). Among the children who used mobile phones for more than a year, 32.1% screened positive for ADHD (OR=3.21, CI 1.41-7.32). The mean ADHD score was significantly higher among children with >1 hour of mobile phone use/day than those who use <1 hour/day (t-test=-2.27 p-value=0.025). The vast majority, 148 (94.2%), also noticed behavioural changes among children when denied mobile phones. Significant changes included anger (22.9%), sadness (31.8%), withdrawal (20%), frustration (17.8%) and violence (8.9%). Conclusion: In this study, 22.9% of children screened positive for ADHD. Mobile phone use was found to be significantly associated with ADHD.

Detection of Occult Anal Sphincter Injuries in Primipara by 2D Transperineal Ultrasound and its Clinical Association: A Cohort Study

Introduction: Endoanal Ultrasound (EAUS), the gold standard for the detection of occult Obstetric Anal Sphincter Injuries (OASI) has limited clinical application due to its intrusiveness and need for specialised equipment and personnel. A 2D Transperineal Ultrasound (TPU) is simple, non invasive and shows a high degree of agreement with EAUS. Few studies have evaluated the use of 2D TPU in determining the incidence and clinical outcomes of occult OASI in primigravida. Aim: To study the incidence, risk factors, and clinical outcome of occult obstetric anal sphincter injury using 2D TPU in primigravida. Materials and Methods: The present cohort study was conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of Radiology at Guru Teg Bahadur Hospital, Delhi, India, from November 2018 to April 2020. A total of 200 low risk primigravida ≥36 weeks period of gestation underwent baseline TPU of the anal sphincter complex antenatally and on day 2 postpartum. On the basis of difference between pre and postdelivery measurements, they were divided into group I (n=91): women with occult OASI {(diagnosed as thinning of the internal and External Anal Sphincter (EAS), interruption in the anal sphincter, alteration in mucosa and half-moon sign)} and group II (n=109): no OASI. Group I was followed at two and six weeks postpartum with TPU and clinical tests were applied at six weeks to assess clinical outcomes of sphincter injury. Data was analysed using Chi-square test/Fisher’s-exact test for qualitative parameters, Analysis of Variance (ANOVA) for comparison of predelivery and postpartum measurements; and multiple logistic regression for determining sphincter injury determinants. Results: Incidence of occult OASI was 91/200 (45.5%). Significant risk factors for OASI were lower baseline thickness of anal sphincter, position of baby (p=0.028), longer duration of second stage of labour (p<0.001), greater length and angle of episiotomy (p<0.001) and greater baby weight (p=0.042). Group I had significantly lower pelvic floor muscle strength testing score (p<0.001), Digital Rectal Examination Scoring System (DRESS) resting (p=0.013) and squeeze scores (p=0.008), weaker muscle contraction (p<0.001), reduced anal sphincter tone, and was more clinically symptomatic at six weeks postpartum. Conclusion: The technique of 2D TPU is simple and feasible to detect OASI. Women, who sustain OASI, can be followed-up in perineal clinic more meticulously, using TPU for pelvic floor rehabilitation.

Subjective Verification of Refraction- A Quality Indicator: A Cross-sectional Study

MC Chaitra, KM Harshitha, H Mohan Kumar, Sri Archana

Introduction: Subjective refraction helps in establishing the suitable lens for a patient. But it also needs a patient’s cooperation for the proper estimation of the refractive error. Subjective refraction determines the combination of lenses to attain the best corrected visual acuity. The examination is conducted by orthoptists, optometrists and ophthalmologists. The advantages of subjective refraction are that it can be performed even in absence of special equipment and good pupillary reflex. Aim: To determine the impact of counselling of Optometrists on subjective refraction and spectacle prescription to patients attending Ophthalmology Outpatient Department (OPD) at their first visit. Materials and Methods: This was a cross-sectional study conducted for a period of two months from June 2020 to July 2020. All patients attending the OPD of Ophthalmology at R L Jalappa Hospital and Research Centre, Tamaka, Karnataka, India, were included in the study. A total of 120 patients, whose vision was <6/9, were included in each group. Group A, before counselling the Optometrists and group B, after counselling the Optometrists by systemic random sampling method. The number of patients who required spectacle correction and those who were given spectacle prescriptions at their first visit were identified. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A total of 240 patients were included in the study, out of which 126 patients were females and 114 patients were males. The patients were divided into two groups, group A and B (120 patients in each group). In group A, out of 120 patients only 62 patients (51.7%), had undergone subjective refraction along with spectacle prescription at their first visit. In group B, (88.3%) 106 patients out of 120, underwent subjective refraction and spectacle correction was given on their first visit. Conclusion: The present study shows a clear positive impact of counselling to Optometrists and the importance of counselling in achieving patient’s satisfaction.

Efficacy and Safety of Laser Photocoagulation in Persistent Idiopathic Central Serous Chorioretinopathy: A Prospective Interventional Study

Rama Balasaheb Kalekar, Shailendra Deshmukh

Introduction: Central Serous Chorioretinopathy (CSCR) encompasses the macular area, secondary to the accumulation of subretinal fluid and increased permeability from the choriocapillaris resulting in focal or diffuse dysfunction of the retinal pigment epithelium. Diagnosis of CSCR is done by several procedures like clinical examination, Amsler grid testing, fluorescein angiography, ocular coherence tomography. There are several treatment options including photodynamic therapy, laser photocoagulation, etc., for CSCR. Aim: To study the efficacy and safety of laser photocoagulation in persistent idiopathic CSCR. Materials and Methods: The present prospective interventional study was conducted in the Department of Ophthalmology, BJ Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India, from August 2019 to January 2021. A total of 30 patients (30 eyes) with idiopathic CSCR, persistent for duration of three months or more with worsening of visual symptoms, active leakage on Fundus Fluoresceine Angiography (FFA) were subjected to 532 nm subthreshold green laser photocoagulation treatment after routine investigations. Statistical analysis was done on International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: In the present study, there was male preponderance (86.7%) for the CSCR cases. The mean±Standard Deviation (SD) age of in the study was 37.7±0.07 years. All the eyes studied had unilateral involvement with 53.35% right eye involvement and 46.7% left eye involvement. The duration of current episode of CSCR in months showed a mean+SD of 5.86±1.40. The distribution of visual acuity in affected eye (before laser treatment) depicts the mean prelaser Best Corrected Visual Acuity (BCVA) of 30 patients at baseline was (0.68±0.20) in LogMAR. About 67% patients experienced central scotoma and 33% patients had metamorphopsia on Amsler chart. Distribution of active leakage site on FFA showed that 43% cases had active leakage in superonasal quadrant, 30% had active leakage in superotemporal, 17% had active leak in inferonasal quadrant and 10% had active leak in inferotemporal quadrant. CSCR associated with or without Retinal Pigment Epithelium (RPE) atrophy showed that 63.3% patients had RPE atrophy suggesting long-standing course of disease with Neurosensory Retinal Detachment (NSD) and subretinal fluid collection affecting RPE. Prelaser mean CMT on OCT of affected eye was 445.83±54.79 μm which was reduced to mean CMT of 303.57±48.49 μm at four weeks follow-up, which further reduced to mean CMT of 224.9±20 μm at end of 12 weeks was statistically significant with p-value <0.001. The statistical analysis for the macular thickness at four weeks and 12 weeks showed significant probability with paired t-test with p-value <0.001. Conclusion: It can be concluded from the present study that early treatment with laser photocoagulation is efficient in the restoration of vision within a period of 12 weeks.

Effect of Intravitreal Injection of Ranibizumab on Diabetic Macular Oedema at a Tertiary Centre in West Bengal: A Prospective Study

Vysakh Balan, Atanu Biswas

Introduction: Diabetic Retinopathy (DR) is one among the many causes of visual loss in people all over the world. Diabetic Macular Oedema (DME) is the most common among vision threatening complications of DR, with a major impact on quality of life of the patient. The intravitreal ranibizumab injection anti Vascular Endothelial Growth Factor (VEGF), which prevents neovascularisation, is given monthly with approved dose of 0.3/0.5 mg with or without laser in the option of choice for all cases of central involving macular oedema. Aim: To find out the effectiveness of injection ranibizumab on patients with DME and to provide the better line of treatment for DME patients. Materials and Methods: This prospective study with quasi-experimental design constituted all the Type I and II Diabetic patients attending Outpatient Department (OPD) in College of Medicine and JNM Hospital, West Bengal, India from December 2019 to January 2021. Spectral Domain Optical Coherence Tomography (SD-OCT) images were obtained and used to diagnose macular oedema. Intravitreal injection ranibizumab (0.5 mg) was given as a standard treatment protocol with a dose interval of one month to all the DME patients. Foveal Thickness (FT) and Visual Acuity (VA) were evaluated before and after one month of injection. The t-test was used to compare the mean value of Central Macular Thickness (CMT) before and after intervention, p<0.05 was considered for statistical significance. Results: A total of 105 patients (54 females and 51 males), were included. The mean age of the population was 55.1 years and gender distribution being: females- 54 (51.4%) and males- 51 (48.6%). Mean duration of diabetes was 10.7 years. CMT value significantly decreased from mean of 416.0095 to 383.8667 after injection. The mean LogMAR value significantly decreased from 1.0350 to 0.8625 after injection. Positive correlation was found between LogMAR after treatment with CMT (r-0.857; p-value <0.0001). Conclusion: Single dose of 0.5 mg of intravitreal injection of ranibizumab is effective in decreasing the CMT and improving VA in patients with DME.

Assessment of the Effectiveness of Kinetic Chain Approach for Primary Adhesive Capsulitis of Shoulder- An Experimental Study

Prabhu Ram Krishna Pandian, Deepak Raghav, Amit Dwivedi

Introduction: Idiopathic adhesive capsulitis is characterised by gradual onset of pain in shoulder and its limited mobility of motion due to a thickened capsule with an unknown cause. The peak incidence rate is between the age group of 40 and 60 years with less chances of occurrence in the younger group and individuals, who engage in physical labour are far less likely to experience it. In order to determine whether the kinetic chain approach is more effective, researchers tested it on individuals with adhesive capsulitis. Aim: To assess effectiveness of the kinetic chain approach for treating primary adhesive capsulitis. Materials and Methods: This pre and postexperimental study was conducted at the Department of Physiotherapy, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India, for a period of one year from January 2020 to December 2020. A total of 60 patients with primary adhesive capsulitis were included in the trial and were divided into group A and group B using a systematic random sampling process. Group A received traditional physiotherapy in addition to the Kinetic chain technique. In group B, regular physiotherapy was the only treatment provided to patients. The Range of Motion (ROM), Visual Analog Scale (VAS) and the Shoulder Pain and Disability Index (SPADI) were measured in both groups pretreatment, mid and post-treatment groups. Non parametric statistical techniques were used to analyse the data owing its originality. Results: A total of 30 patients in each group (A and B) were provided with Kinetic chain approach (mean age=53.93 years) and conventional physiotherapy (mean age=55.40 years), respectively. For comparing data within the same group, Wilcoxon signed-ranks test was used for this. Mann Whitney U-test was used to compare the data between groups. The p-values for the VAS, SPADI, and ROM showed statistical significance at the <0.001 level. In terms of pain, functional impairment, and range of motion, with group A showing greater strides than group B. Conclusion: The combination of kinetic chain technique and traditional physiotherapy was more beneficial than either group when used singularly to reduce discomfort, increase the range of motion, and enhance functional capacity in adhesive capsulitis patients.

Impact of Correlation between Multiple Time Point Measurements on Pooled Effect Measures in Meta-analysis

Deepthy Melepurakkal Sadanandan, N Sreekumaran Nair, KT Harichandrakumar

Introduction: Effect estimates obtained from multiple time points based on the same set of subjects are observed to be correlated. There is a need to integrate these correlations in the derivation of pooled summary measures to improve the precision of estimates. The conventional meta-analysis does not consider this dependency into account. Aim: To compare the results obtained from meta-analysis which incorporate various levels of correlation in repeated measures data to the traditional meta-analysis. Materials and Methods: The present statistical analytical study was conducted at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from January 2021 to February 2022 on data from a systematic review that studied the effect of analgesics in reducing orthodontic pain using Visual Analogue Scale (VAS) pain score measured at three time points were used for demonstration. This study attempted to illustrate two distinct approaches to deal with dependency between measurements obtained from different follow-ups by adopting constant and degenerating correlation structures. Results: The pooled effect estimates and confidence intervals obtained from models which incorporated correlation were different from the results of traditional approach. Naproxen fared to be better when compared to other two treatments. Pooled effect estimates and confidence intervals from Model 2 and Model 3 hovered around the same values. Non significant difference was observed in the Akaike Information Criterion (AIC) values of Model 2 and Model 3 for all three treatments. The between study variance ranged from 0.07 to 1.46, 1.25 to 3.17 and 0.01 to 0.98 for Acetaminophen, Naproxen and Ibuprofen, respectively. Conclusion: The models which took care of dependency had a better fit to the data over conventional meta-analysis.

Screening for Latent and Active Tuberculosis in Paediatric Contacts of Tuberculosis Patients: A Cross-sectional Study

Gursharan Singh Narang, Preeti Malhotra, Rahul Puri, Ashwani Kumar

Introduction: Globally, World Health Organisation (WHO) estimate suggests that, one million cases of Tuberculosis (TB) occur among children (approximate 10% of the total 9.6 million TB cases). As per Revised National Tuberculosis Control Programme (RNTCP), high importance and priority is given to the household contacts and paediatric age group (especially <6 years). Since, transmission can happen at any time from index case to the contact (before diagnosis or during treatment), all contacts of TB patients should be screened. Aim: To focus on the screening of paediatric contacts of TB positive patients by Mantoux test and to find out active and latent TB. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India. The duration of the study was 16 months, from February 2020 to June 2021. Participants, who were proven cases, either sputum positive or clinically diagnosed and were less than 18 years of age were included. Contacts in whom Isoniazid Preventive Therapy (IPT) had been started were excluded. The candidates who tested Mantoux positive and had symptoms of TB were further screened by following test chest X-ray, Ultrasonography (USG) abdomen, Microscopy for Acid Fast Bacilli (AFB), Cartridge Based Nucliec Acid Amplification Test (CBNAAT), Cerebrospinal Fluid (CSF) analysis and contrast Magnetic Resonance Imaging (MRI). The data collected was analysed statistically with Statistical Package for Social Sciences (SPSS) version 26.0 and the level of significance was determined p-value <0.05 as insignificant, p-value >0.05 as significant and p-value <0.001 as highly significant. Results: A total of 82 contacts were included. Out of these, 60 children had no organ system involvement, whilst 11 had lymphadenopathy, five had respiratory involvement and six had abdominal involvement. Out of 82 contacts, 23 children tested Mantoux positive and 59 tested negative. Out of 23 Mantoux positive contacts 16 (19.51%) had latent TB and only 1 (2.44%) had active TB. Conclusion: A significant number of children in contact with TB positive patients were found to have latent TB, and it is possible that, there can be activation from latent to active TB later on in these children.

Incidence of Ossification of Caroticoclinoid Ligament in Dry Adult Human Skulls with its Surgical Implications: A Cross-sectional Study from Telangana Region, India

Introduction: The caroticoclinoid ligament extends from the Anterior Clinoid Process (ACP) to the Middle Clinoid Process (MCP). Occasionally, it gets ossified and forms the caroticoclinoid foramen. Anterior clinoidectomy is a common surgical procedure to treat internal carotid artery aneurysms or pituitary tumours. Abnormal ossification of the caroticoclinoid ligament may lead to intraoperative or postoperative complications as it is not normally present. Aim: To find out the incidence of ossification of the caroticoclinoid ligament in adult human skulls. Materials and Methods: This was an observational cross-sectional study which was conducted in the Department of Anatomy at Gandhi Medical College, Hyderabad, India from January 2021 to February 2023. The study had included 100 dry adult human skulls with open vault were collected from the Department of Anatomy, Gandhi Medical College, Secunderabad; Osmania Medical College, Hyderabad; Bhaskar Medical College, Moinabad, Telangana, India. All the skulls were observed and skulls damaged in the clinoid regions were excluded from the study. The skulls were observed for the presence of any ossifications of the caroticoclinoid ligaments and the observations were noted. The qualitative data was presented as number and percentage was calculated. The data was recorded in Microsoft excel version 2021. Results: The incidence of ossification of caroticoclinoid ligament was 8 (8%). The incidence was higher on right-side when compared to the left-side. Bilateral complete ossification of the caroticoclinoid ligament was observed in 2 (2%) skulls; bilateral incomplete ossification was observed in 2 (2%) skulls, unilateral complete ossification was observed in 2 (2%) skulls on the right-side. In one skull 1 (1%), complete ossification was observed on the right-side and incomplete ossification was observed on the left-side. Conclusion: Knowledge of the ossification of the caroticoclinoid ligament is important for neurosurgeons, while performing anterior clinoidectomies or skull base surgeries. Radiological confirmation of the ossification of the caroticoclinoid ligament is essential to avoid complications.

Comparison of Bipolar and Monopolar Transurethral Resection of Bladder Tumours: A Randomised Clinical Study

MD Faizul Haque, Samir Swain, Aparajita Mishra, Sabyasachi Panda, Datteswar Hota

Introduction: The standard treatment of Urinary Bladder Cancer (UBC) is Transurethral Resection of Bladder Tumours (TURBT) commonly using a monopolar resection system. Bipolar-TURBT (B-TURBT) is associated with better haemostasis than Monopolar-TURBT (M-TURBT). Despite this, there exists controversy whether B-TURBT can completely replace M-TURBT. Aim: To assess the perioperative outcomes of B-TURBT and compare it with the conventional monopolar system (M-TURBT). Materials and Methods: The present randomised clinical study was conducted in the Department of Urology at SCB Medical College, Cuttack, Odisha, India between January 2018 and January 2020. Fifty patients of either sex, aged >18 years with urinary bladder tumour size of ≤4 cm were included in the study. Patients were randomly assigned into B-TURBT and M-TURBT treatment groups. Demographic data (age and sex), morphology, location, shape, grade, stages of transitional cell carcinoma, degree of artifact were analysed and compared. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. The qualitative and quantitative variables between the groups were compared using independent sample t-test and chi-square test, respectively. A p-value <0.05 was considered statistically significant. Results: A total of 50 patients with UBC were evaluated in the present study where the majority of patients were male 45 (90.0%) with mean age 60.9 years. The most common morphologies were papillary tumour (28.0%), broad solid mass (22.0%), and papillary solitary (22.0%). Total 25 patients underwent M-TURBT and 25 patients underwent B-TURBT. Older patients (>55 years) had a higher rate of severe artifact compared to younger patients (<55 years). The B-TURBT had a significantly lower rate of artifact compared to M-TURBT (p-value <0.001). The need for secondary procedure was comparatively higher in M-TURBT than in bipolar resection (p-value=0.253). The obturator jerk and bladder perforation were not observed in this study. Conclusion: The B-TURBT had a lower incidence of severe artifact and restaged TURBT as compared to M-TURBT. Thus, B-TURBT is a safer and more effective treatment for patients with UBC.

Cardiovascular Complications in Patients with Kawasaki Disease in a Tertiary Care Hospital in West Bengal, Eastern India- A Prospective Clinical Study

Sayani Pan, Uttam Kumar Roy, Nilanjan Ghosh, Tarak Nath Ghosh

Introduction: Kawasaki Disease (KD) is an acute self-limiting systemic vasculitis involving medium and small sized arteries. It may soon replace rheumatic fever to become the most common cause of acquired heart disease in Indian children. Coronary Artery Aneurysm (CAA) which can develop in 15-25% of untreated children remains the most dreaded complication of KD. Predicting the risk of CAA and taking timely measures can help in reducing the fatality of the condition. Aim: To study the spectrum of cardiovascular complications in patients with KD and also to assess associated risk factors for developing CAA in the patients under study. Materials and Methods: The prospective clinical study was carried out in the Paediatric Medicine Ward, Burdwan Medical College and Hospital, West Bengal, Eastern India, from 1st January, 2020 to 31st May, 2021. A total of 52 children diagnosed with KD, aged between one month to 12 years, were included and followed-up for six months. Data regarding demographic variables, duration of fever, Intravenous Immunoglobulin (IVIG) resistance, hepatomegaly, neutrophilia, thrombocytopaenia, haematocrit, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), hepatic transaminases (alanine transaminase, aspartate amino-transferase), hyponatraemia, hypoalbuminaemia, and N-terminal-brain natriuretic peptide (NT-proBNP) were collected. Univariate and multivariate regression analyses were done using these variables for assessment of risk factors. Results: In the present study, out of 52 children, 28 (53.85%) were males and 24 (46.15%) were females with mean age of 3.74±2.55 years. Cardiovascular complications were observed in 27 (51.92%) patients, of whom 19 (35.54%) had CAA. Duration of fever ≥10 days, IVIG resistance, thrombocytopaenia, low haematocrit, Alanine Transaminase (ALT) ≥100 U/L, hypoalbuminaemia, and raised NT-proBNP were proven to be significant risk factors for development of CAA on univariate analysis. Thrombocytopaenia and raised NT-proBNP came across as significant on binary logistic regression analysis. Conclusion: In this study, one or more types of cardiovascular abnormalities were present in 51.92% cases. Seven risk factors were identified to be significant in development of CAA on univariate analysis and among them two were proven significant in binary logistic regression.

Comparison of Demographic Factors and Personal Lifestyle Characteristics with 2020 ISH Guidelines for High Normal Blood Pressure in Relation to Absence and Presence of ECG Diagnosed LVH in Healthy Adults: A Cross-sectional Study

Pravin Sainikrao Gowardipe, Kiran R Bagale, Saurabh K Sahu, Satyajit Singh

Introduction: Early identification of Left Ventricular Hypertrophy (LVH), a powerful and independent predictor of Cardiovascular Disease (CVD), is a key element for preventing Cardiovascular Events (CVE). High-Normal Blood Pressure (HNBP) was significantly associated with a new-onset Electrocardiogram (ECG) diagnosed LVH. The demographic and personal lifestyle characteristics could be related to HNBP in ECG diagnosed LVH. This relation, if found, can be useful as a factor for early identification of HNBP in relation to ECG diagnosed LVH. Aim: To compare demographic and personal lifestyle characteristics with HNBP in relation to ECG diagnosed LVH in healthy adults. Materials and Methods: The cross-sectional study was conducted in AIIMS Raipur (CG) Raipur, Amboli, Maharashtra, India from April 2021 to March 2022 among 95 healthy adult males between 20-39 years with a Blood Pressure (BP) of 130-139/85-89 mmHg and no antihypertensive medications. Permission was obtained from the Ethics committee of AIIMS Raipur (CG). Data was collected from the individuals using health questionnaire, Personal Lifestyle Questionnaire (PLQ), validated anthropometric equipment stature metre for measuring height and weighing machine, a working electronic BP measuring instrument, and ECG. The present study included demographic factors like age, height, weight, Body Mass Index (BMI), educational level, marital status, occupation, and Socio-Economic Status (SES) classified based on Kuppuswamy’s classification. The personal lifestyle characteristics included physical activity, use of substances (alcohol, smoking, tobacco, gutkha), and diet. The unpaired t-test, Chi-square test and regression analysis were applied for the analysis of the collected data. Results: Representation of demographic factors were age (31.9±5.08), height (1.69±0.06), weight (68.3±10.2), BMI (23.8±3.05) in terms of (mean±SD) and SES in terms of n (%) were upper I-7 (7.4), upper middle II-31 (32.6), lower middle III-30 (31.6), upper lower IV-25 (26.3), lower V-2 (2.1). SES classes of modified Kuppuswamy’s SES scale had a significant relationship with LVH {p-value <0.05 (0.003)}. All LVH (+) individuals were from the lower middle III SES class {7 (7.4%)}. Daily use of substances (alcohol, smoking, tobacco, gutkha) had a significant association with LVH {p-value <0.05 (0.005)}. Group-IV (35-39 years) (standard coefficient 0.4621059, 95%CI-0.0385065 to 0.4686115; p-value-0.021) had more positive relation than Group-II (25-29 years) (std. coef. 0.4422758, 95% CI-0.0501719 to 0.4566986; p-value-0.015). Primary Educational level (std. coef.-0.2473403, 95% CI-0.8019454 to-0.0982954; p-value-0.013) had a negative relation with SL-LVH (p<0.05). Conclusion: The study concluded that lower middle III class SES and daily use of substances (alcohol, smoking, tobacco, gutkha), age Group-IV (35-39 years), and primary educational level were the predicted demographic and lifestyle characteristics of HNBP in relation to ECG diagnosed LVH.

Comparison of Serum CRP, Total Cholesterol, Magnesium and Uric Acid in Smoker and Non Smoker Patients with COPD: A Cross-sectional Study

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common and treatable disease characterised by progressive airflow limitation and tissue destruction. Smoking is a common risk factor but non smokers can also develop COPD. There may be change in serum level of inflammatory marker, oxidative stress markers, bio-markers among these patients. In this study smoker and non smoker group in COPD patients were studied which could be helpful for comparing levels and for associating with severity of disease and also for group specific management. Aim: To evaluate the level of Serum C-Reactive Protein (CRP), total cholesterol, Magnesium (Mg++), and uric acid in COPD patients and also, to compare these parameters in smoker and non smoker patients with COPD. Materials and Methods: This cross-sectional study was conducted in Department of Biochemistry and Department of Pulmonary Medicine at People’s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India, from October 2021 to December 2022. A total of 100 COPD patients, aged between 40-60 years were included and divided into two groups: 50 smokers and 50 non smokers. Parameters such as CRP, Mg++, total cholesterol and uric acid, were estimated by autoanalyser. Data were statistically analysed using unpaired t-test. Results: In smokers, mean age was 53.08±5.89 years, whereas in non smokers, mean age was 53.9±4.84 years. Out of the 100 subjects, 50 were smokers (F=6 and M=44) and 50 were non smokers (F=6 and M=44). The present study, observed increased CRP levels and cholesterol levels, low serum magnesium, and normal uric acid in smoker in comparison to non smokers COPD. There was significant difference in cholesterol (p-value=0.044), serum magnesium (p-value=0.001) and CRP levels (p-value=0.0001) but there was no significant difference in uric acid (p-value=0.989). Conclusion: Smokers with COPD had increased level of CRP, Cholesterol and low level of Magnesium as compared to non smoker COPD patients. This may attribute that smokers COPD patients are in risk of developing recurrent exacerbations and more disease severity.

Utility of Contrast-enhanced 3D T1-weighted CUBE Fat Sat Sequence MRI to Evaluate Pathological Cranial Nerve Enhancement: A Cross-sectional Study

Ruchi Gupta, Aishwerya Singh, Manisha Kumari, Sanjay Kumar Suman, Neetu Sinha

Introduction: Abnormal Cranial Nerve (CN) enhancement can point towards an underlying disorder or disease severity. Therefore, the depiction of this feature is of utmost importance in the evaluation of various pathologies. Various Magnetic Resonance Imaging (MRI) sequences have a role in the early identification of such findings. Aim: To study the spectrum of cases of abnormal CN enhancement on MRI and the role of contrast-enhanced 3 Dimensional (3D) T1-weighted CUBE Fat saturated sequence in evaluating pathological CN enhancement. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. The duration of the study was two years, from June 2020 to June 2022. Study included 50 patients who presented with signs and symptoms of CN involvement or were referred for other pathologies with incidental detection of pathological nerve enhancement on 1.5 Tesla (T) MRI Scanner. The data was transferred to a Microsoft excel 2010 sheet and results were expressed in terms of frequency and percentages. Results: The mean age of the study participants was 33.3±20.9 years. Male to female ratio was 28:22=1.27:1. Infections were the most common cause of abnormal CN enhancement 26 (52%) cases followed by demyelination 3 (6%) cases, haematological malignancy 4 (8%) cases, metastatic neural infiltration 5 (20%), primary neural tumours 4 (18%), Bell’s palsy 1 (2%) case, Tolosa Hunt Syndrome (THS) 1 (2%) case and idiopathic polyneuritis cranialis 1 (2%) case. Conclusion: Contrast-enhanced 3D T1 CUBE Fat Saturation (FS) sequence is excellent in depicting abnormal CN enhancement, especially the cisternal segments.

The Translation Process, Validity and Reliability Study in Occupational Health Psychology amongst Healthcare Professionals by Multitrait-Multimethod Matrix: A Multimethod Study

Deepak B Sharma, Himanshu K Sharma

Introduction: Questionnaires are designed to measure specific constructs. Occupational Health Psychology (OHP) includes various domains/areas like work place well-being, work related stress, flourishing, resilient coping, coping mechanisms, compassion satisfaction, burnout and secondary traumatic stress. At times, specific questionnaire may not be available and if available, may not be in the language intended to be used by the respondents. A new questionnaire needs to be developed or translation of an available questionnaire into the respondents’ language is required in such case. Aim: To detail out the translation process of the study tools (questionnaires/scales) and to assess the validity and reliability of these study tools used in OHP. Materials and Methods: The present cross-sectional, Quasi-experimental study was conducted in the Department of Community Medicine, Pramukhswami Medical College, Anand District, Gujarat, India, from February 2021 to January 2023 using multimethod study design amongst the healthcare professionals. For translation, standard World Health Organisation (WHO) translation guide was followed. Nine scales/questionnaires along with a socio-demographic and a qualitative proforma were finalised to achieve the objectives. The questionnaires availability in public domain was taken into consideration while selecting the questionnaires. Reliability analysis and validity assessment were done. Reliability measure was checked for internal consistency by calculating Cronbach’s alpha. Construct validity was assessed by Multitrait-Multimethod Matrix. Translation was done in Hindi and Gujarati languages. Results: Flourishing scale (FS), Brief resilient coping scale, compassion satisfaction and work satisfaction were positively correlated and all these were negatively correlated with all the stress measures, Depression, anxiety measures of Depression, Anxiety and Stress Scale (DASS), burn out and secondary traumatic stress. Cronbach’s alpha for internal consistency measure was calculated for different sub domains of the nine questionnaires. Construct validity was analysed by calculating correlation coefficients between different identified constructs/ sub constructs. Variables measuring similar construct were found to be positively correlated and significant. Conclusion: Variables/questionnaires measuring a similar construct were found to be positively correlated and significant, while opposite constructs were negatively correlated. The questionnaires need to be translated in the language in which the participants can understand. The better linguistic comprehension will increase the internal validity of the study.

Qualitative Analysis of the Right Plantar Dermatoglyphic Configurations in Himachal Pradesh: A Dimorphic Study

Meenal Ohri, Minu Bedi, Harish Chaturvedi

Introduction: Dermatoglyphics is defined as the study of the configurations on the plantar aspect of the feet and the palmar aspect of the hands. It is a well-established fact that these epidermal configurations are distinct for each and every individual. Aim: To study and analyse the plantar dermatoglyphic patterns on the right sole of the individuals of Himachal Pradesh and to know its implication in gender determination. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy, Adesh Institute of Medical Sciences, Bathinda, Punjab, India, and the data was collected over a period of one year (May 2021 to May 2022). The sole dermatoglyphic prints of 400 individuals (200 males and 200 females) of the age group 18-45 years without any known medical conditions were analysed for the dermatoglyphic patterns visualised in the Hallucal/Thenar/First Interdigital Area (Rt Th/H/ID1), Second Interdigital Area (Rt ID2), Third Interdigital Area (Rt ID3), Fouth Interdigital Area (Rt ID4), Hypothenar Distal Area (Rt HTD), Hypothenar Proximal Area (Rt HTP) and the Calcar Area (Rt C) of the right sole. The findings thus obtained were then subjected to Chi-square test using the Statistical Package for the Social Sciences (SPSS) version 21.0 software. Results: The mean age of the subjects included in the study was 29±4 years and 16±7 years for 200 males and 200 females, respectively. The study showed that there was indeed an association between the right plantar dermatoglyphic patterns and the sex of the people. The distribution of the dermatoglyphic patterns on Rt Th/H/ID1 of the females were significantly different from the males (p-value <0.05). On the Rt ID2, Rt ID3 and Rt ID4, the differences observed between the females and males were highly significant (p-value <0.001) whereas on the Rt HTD, Rt HTP and the Rt C, all the males and females depicted a lack of pattern. Conclusion: It is concluded from the present study that there exist some significant differences between the male and female subjects of Himachali population. The plantar dermatoglyphic patterns could therefore be utilised as an important tool to determine the gender of an individual in forensic and medico-legal aspects as well as to determine the relationship of an individual to an ethnic group based in different geographical areas.

Efficiency of Bimanual Hand Coordination among Type 2 Diabetes Mellitus Adults: A Case-control Study

Taitiksh Jakhar, Ashwini KShetty, Jagadamba Aswathappa, SV Srinivasa

Introduction: Distal Peripheral Neuropathy (DPN), which first affects the lower limbs and then the upper limbs, is one of the common complications of Type 2 Diabetes Mellitus (T2DM). In addition to DPN, diabetic patients have lower muscle quality than non diabetic patients, which is exacerbated by longer duration of diabetes and poor glycaemic control. Diabetic induced peripheral neuropathy and changes in the muscle strength may interfere with bimanual coordination, which refers to a wide range of situations in which the brain must control multiple movements at the same time such as performing a task with two hands. Aim: To assess and compare Efficiency Index (EI) of bimanual coordination in T2DM and controls. Materials and Methods: This case-control study was conducted conducted in the Department of Physiology at Shri RL Jalapa Hospital, Kolar, Karnataka, India, from August 2019 to September 2019. The study included 50 participants, 25 with T2DM and 25 age-matched controls. The bimanual hand coordination test apparatus was used to assess the efficiency of bimanual hand coordination. The data obtained was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of the study participants was 57.16±9.54 years and controls was 54.15±5.52 years and were age-matched with p-value >0.426. Mean HbA1c of the cases was 8.36±1.88 mmol/mol. There was significant decrease in efficiency of bimanual coordination among type 2 diabetics as compared to non diabetics (p-value <0.001). Conclusion: The findings of the present study showed a decrease in bimanual coordination efficiency among diabetics, indicating the importance of performing hand function tests in T2DM alongside other routine examinations.

Incidence of Staphylococcus aureus in Lower Respiratory Tract Infections: An Emerging Trend

Sunil Sonu Hatkar

Introduction: The pathogen like staphylococcus spp. associated with multidrug resistance is one of the major concerns. Prompt diagnosis of staphylococcal Lower Respiratory Tract Infection (LRTI) with its antibiogram plays a vital role in better outcomes of treatment and reducing the cost of hospital stay of patients. Aim: To find out incidence of staphylococcal LRTIs. Materials and Methods: This prosprective cross-sectional study was conducted in the Department of Microbiology, SMBT Institute of Medical Sciences and Research Centre, Nashik, Maharashtra, India. The duration of the study was 23 months, from June 2017 to May 2019. Total 421 specimens were screened for staphylococcal species as per the standard bacteriological procedure. The Gram-positive, catalase-positive isolates were further subjected to detection of antimicrobial susceptibility patterns as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The data was analysed by using Statistical Package for Social Sciences (SPPS) version 20.0. Results: The majority of the patients were of old age groups and the average mean age was 57.95±6.18 years. A total of 22/421 Staphylococcus aureus (S. aureus) were isolated from the patients suffering from LRTIs. High incidence was noted in male patients 21/22 (95.5%) than in females 1/22 (4.5%) and 100% of patients were hospitalised with a complaint of LRTIs. The majority of strains were isolated from sputum sample 18/22 (81.8%), followed by 3/22 (13.6%) from pleural aspiration, and 1/22 (4.5%) from endotracheal secretion. Almost 18/22 (81.8%) patients were of pneumonia, followed by 3/22 (13.6%) were of empyema and 1/22 (4.5%) were of sinusitis. All the isolates were sensitive to linezolid, vancomycin, and ceftaroline. Conclusion: In the present study, LRTI associated with S. aureus was found to be (5.22%). It was also observed that, all strains were sensitive to vancomycin, linezolid, and ceftaroline which is unique. Hence, the staphylococcal infection can be treated with low cost and hospital stay if diagnosed in time by microbiological profile, as the clinical presentation and susceptibility to antimicrobial agents vary in different geographical areas.

Expression of PD-L1 in Microsatellite Instability High Tumours: A Retrospective Study

Introduction: Microsatellite Instability (MSI) is the hallmark of Lynch syndrome/Constitutional Mismatch Repair Deficiency (CMMRD) and is also found in many sporadic cancers like colorectal cancer, endometrial, gastric, small intestine, urothelial, central nervous system and sebaceous gland neoplasms. MSI is a predictive biomarker for immunotherapy and Immunohistochemistry (IHC) antibodies against four Mismatch Repair (MMR) proteins: MutL Homolog 1 (MLH1), MutS Homolog 2 (MSH2), MutS Homolog 6 (MSH6) and Postmeiotic Segregation increased 2 (PMS2) can identify the MSI status of the tumour. In addition to MSI, immune checkpoint Programmed Cell Death Protein 1 (PD-1) expression and its ligand PD-L1 are biomarkers that can predict response to immunotherapy. Considering this increasing interest to identify deficient MMR (dMMR) status in different cancers, authors have assessed the expression of PD-L1 and status of MSI in various cancer types. Aim: To evaluate the expression of PD-L1 in MSI-high status tumours. Materials and Methods: This retrospective cross-sectional study was done in the Department of Pathology, Panimalar Medical College Hospital and Research Institute, Chennai, Tamil Nadu, India for a period of six months from July 2022 to December 2022. A total of 151 cases were identified for the period of three years from January 2020 to December 2022. The slides and blocks were retrieved from the archives. Tumour sections from the paraffin embedded tissues were deparaffinised and antigen retrieval was done. IHC using four antibodies (MLH1, MH2, MSH6 and PMS2) was performed on these slides to assess the MSI status. The slides were reviewed and were further subjected to PD-L1 IHC. PD-L1 expression on tumour cells was compared with the MSI status of different cancer types. The p-value was calculated using t-test and p<0.5 was considered statistically significant. Statistical analysis was done using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: A total of 151 cases were included in the present study. A positive nuclear stain for the four MMR proteins denote expression of wild type MMR proteins, hence MSI low status. A loss of nuclear expression denotes mutation of MMR proteins and hence MSI high (MSI-H) status. The MSI was high in nine out of 48 cases (18.75%) of colon cancer, three out of 15 cases (20%) of endometrial cancers, three out of 20 cases (15%) of gastric cancers. Rest were one out of sixteen cases of ovarian cancer, one out of two malignant melanoma and one out of three glioblastoma. Out of these, PD-L1 was positive in seven of the 18 MSI-H cases (38.88% of MSI-H cases). The MSI was low/stable in the remaining 133 cases. The p-value of significance was 0.03 (statistically significant). Conclusion: This study shows a significant association of MSI-H with PD-L1 expression in tumours. Further large scale studies can help in assessing the role of PD-L1 as an effective therapeutic biomarker in MSI-high status patients who can benefit from targeted therapy.

Effect of Intravenous Etomidate versus Propofol on Seizure duration and Haemodynamic Response during Modified Electroconvulsive Therapy: A Randomised Clinical Trial

Introduction: Seizure duration in Electro convulsive Therapy (ECT) is a clinically important factor in managing psychiatric patients subjected to the procedure. Various induction agents are being used with varying efficacy on seizure duration and haemodynamic response like thiopentone, propofol, ketamine and etomidate. As repeated ECT sessions pose significant risk of general anaesthesia and its complications, in this study the efficacy of etomidate and propofol was compared. Aim: To assess the seizure duration and compare haemodynamic variables using etomidate and propofol. Materials and Methods: A randomised double-blinded, clinical trial was done in the Department of Anaesthesiology, at tertiary care hospital between July 2021 to June 2022 on 40 patients of age group 18-60 years of either sex, belonging to American Society of Anaesthesiologists (ASA) Grade I and II scheduled for ECT. Patients were allocated into two groups. Preinduction baseline values of Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded using pulse oximeter and Non Invasive Blood Pressure (NIBP). Patients were induced with either, inj. etomidate 0.2 mg/kg (Group E) or inj. propofol 1 mg/kg (Group P). HR, SBP, DBP and MAP were recorded soon after induction, after application of stimulus and at one minute interval after electric 156 shock for five minutes and then at five minutes interval. Statistical analysis was done by using the unpaired Student’s t-test for quantitative data. The p-value <0.05 was considered significant. Results: Demographic data were similar in both the groups. The mean seizure duration in Group E (51.25±9.01 seconds) was greater than in Group P (38.30±9.92 seconds) and was statistically significant. There was significant increase in the HR in both groups and the HR did not reach the baseline even after 10 minutes. There was a rise in the mean SBP by approximately 7 mmHg in the Group P compared to 4 mmHg in the Group E. The mean DBP rise in the propofol group was 6 mmHg as compared to 5 mmHg in the Group E. The MAP in both the groups increased by 7 mmHg. The parameters reached the baseline earlier with Group P compared to Group E. Conclusion: The study concludes etomidate has a distinct advantage over propofol in producing seizures of adequate duration during ECT whereas propofol blunts the sympathetic response to ECT more effectively than etomidate.

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine in Ultrasound-guided Supraclavicular Brachial Plexus Block: A Prospective Observational Study

Aavani Sanjeevan, V Rajanigandha, A Harikumar

Introduction: Upper limb surgeries are mostly performed under supraclavicular brachial plexus blocks which provide intraoperative and postoperative analgesia. Ultrasound provides clinicians with real-time images which are useful for better identification of the anatomical structures, safe needle placement, and adequate local anaesthetic spread. Adding adjuvants to local anaesthetic drugs prolong the duration of anaesthesia without concomitantly increasing the risk of complication. Aim: To compare fentanyl and dexmedetomidine when added as an adjuvant to ropivacaine for Ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: A prospective observational, double-blinded study was conducted in the Department of Anaesthesia, at Government Medical College, Kottayam, Kerala, India, on 52 patients undergoing orthopaedic upper limb surgeries over a period of one year from April 2019-March 2020. Patients were divided into two groups of 26 subjects each. Group A received ropivacaine 0.5% (20 mL)+dexmedetomidine 1 mcg/kg and group B received ropivacaine 0.5% (20 mL)+Fentanyl 1 mcg/kg. Onset, time to complete sensory and motor block, duration of sensory and motor block, duration of analgesia, adverse effects and haemodynamic status were monitored. Statistical analysis was done using t-test and Chi-square test. Results: The demographic variables, onset of sensory and motor block were comparable in both the groups. Mean duration of sensory block in group A and B were 638.08±52.001 minutes and 568.85±36.478 minutes, respectively. The mean duration of motor block in group A was 605.77±58.8 minutes and group B was 513.46±14.982 minutes. The mean duration of analgesia in group A and B were 722.3±58.13 and 615.00±48.19 minutes, respectively. Mean duration of sensory block, motor block and analgesia were found more in group A which was statistically significant with p-value ≤0.05. There was no significant difference in haemodynamic parameters. Conclusion: Dexmedetomidine was a better adjuvant to 0.5% ropivacaine as compared to fentanyl in Ultrasound-guided supraclavicular brachial plexus block in terms of duration of sensory block, motor block and analgesia.

Morphometric Analysis of Greater Palatine Foramen and the Adjacent Structures: Forensic Odontology Study using CBCT

Winnifred Christy, S Annapoorani, T Jones Rajadeva Thambi, Mahalakshmi

Introduction: Sexual dimorphism plays a pivotal role in many instances, including solving medicolegal problems, anthropological studies, sorting out victims of natural calamities and man-made calamities. Among various parameters available for sexual dimorphism, structures of the oral cavity play an important role. The use of Cone Beam Computed Tomography (CBCT) is convenient and provides accurate measurements with the help of digital software. Aim: To determine the role of Greater Palatine Foramen (GPF), its Greater Palatine Canal (GPC) and relation with the adjacent structures like Nasopalatine Foramen (NPF) and Lesser Palatine Foramen (LPF) in elucidating the level of sexual dimorphism using CBCT images, while enhancing the information on anatomy of Greater Palatine Foramen (GPF). Materials and Methods: This cross-sectional forensic odontology study was conducted in the Department of Oral Medicine and Radiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India, and was performed using 50 males and 50 females CBCT images of patients between age 18 to 45. The CBCT data were collected from January 2021 till January 2022, and the obtained data were analysed from March 2022 till April 15, 2022. These were analysed using Planmeca imaging software. Measurements of GPF length, angulation with respect to Hard Palate (HP), relation between NPC and GPF, distance between GPC and Mid Maxillary Suture (MMS). Its relation to LPF and dimensions of GPF at opening of oral cavity were done. Finally, all measures were subjected to statistical analysis using IBM Statistical Package for the Social Sciences (SPSS), version 28.0. Independent t-test was used for analysis of difference between male and female measurements. Results: The GPC length on right (male: 13.2570, female: 12.3628) and left (male: 12.8089, female: 12.2780), angulation between left GPC and hard palate (HP) (male: 61.1379, female: 57.4964), angle between GPF and NPC left (male: 28.6208, female: 26.5024), distance between GPC and MMS left (male: 15.1625, female: 14.5350) and Anteroposterior (AP) dimensions of GPF on right (male: 5.5402, female: 4.2314) and left-side (5.4934, female: 4.4576), Transverse dimension of GPF on right (male: 2.6752, female: 2.0528) and left (male: 2.6616, female: 2.1544) showed statistically significant difference between male and female CBCT images, while the measures were significantly higher in males. Conclusion: The CBCT images provided reliable measurements of the areas of interest. The present study results highlight a statistically significant difference between male and female, where males showed higher measurements in most instances. A more precise morphological measurement of GPF in relation to adjacent structures such as NPC, MMS proves to have sexual dimorphism in humans.

Tongue Adaptation and Airway Changes in Two Different Bracket Systems: A Randomised Clinical Trial

Sowmithra Devi Saravanan, Aravind Kumar Subramaniyan

Introduction: Orthodontics apart from correcting the malocclusions provide an invariably indirect effects on surrounding musculature and airway by means of creating room for proper tongue posture which helps in improvement of oropharyngeal airway dimensions along with dentoalveolar corrections which in this study was experimented with two different bracket systems- MBT and Damon self-ligating systems. Aim: To assess the adaptation of tongue and oropharyngeal airway changes following treatment with two different bracket systems. Materials and Methods: This randomised clinical trial was conducted in the Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, and included 20 participants and categorised into two groups: Group 1 and Group 2 included participants who underwent orthodontic treatment with Damon appliance therapy with Damon Copper NiTi (CuNiTi) wires and MBT prescription with Damon CuNiTi wires. Lateral cephalogram and intraoral scanning was done at the start of orthodontic treatment (T0) and after one year (T1). Cephalometric and occlusal model assessment to determine the adaptation of tongue and Oropharyngeal Dimensions (OD) were determined (T0-T1) using the Facad® and 3-shape software. Independent t-tests and paired t-tests were done to compare T0 and T1 for both the groups were done using Statistical Package for the Social Sciences (SPSS) software. Results: Results of paired t-tests showed a statistically significant difference at the Interpremolar distance (IPM1) region of both groups 1 and 2 between T0 and T1 (p=0.034, p=0.011), Intercanine distance (IC) of group 2 upper (p=0.043) and IPM2 of both the groups in the upper arch (p=0.042, p=0.022). Cephalometric results showed a significant increase in all the assessed parameters within the groups between T0 and T1 (p<0.05). Oropharyngeal space did not show any difference in both the systems however comparatively increased in group 1 than in group 2. Conclusion: Treatment with Damon and MBT prescriptions with Damon Cuniti wires showed significant alterations in adaptation of tongue and oropharyngeal space and also in bringing about arch expansion in maxilla and mandible with the greatest expansion noted for first premolar of both the groups and IC and Interpremolar (second premolar) width of the upper arch of both the groups.

Assessment of Knowledge of the DCI Point System among Orthodontists associated with a Dental College to Develop a Colour-coded Guide of Orthodontics Journals

Introduction: The credibility of the published scientific literature is dependent on various dynamic factors like the type of research, type of journal, journal indexing, impact factor which are subjected to constant changes. Calculating publication points, as a form of performance measure to award promotions for postgraduate faculty is used in many developing and in some developed countries. Aim: To determine the knowledge of the Dental Council of India (DCI) point system among orthodontists associated with a Dental College and to develop a colour-coded guide of Orthodontics journals. Materials and Methods: This cross-sectional study was conducted in the Department of Orthodontics, of an Educational Institution from July 2021 to December 2021, and a structured questionnaire was self-designed and made available in Google forms. This cross-sectional epidemiological study was conducted among the orthodontic faculty. A total of 428 complete responses were obtained and all the responses were evaluated using one way analysis of variance with Tukey’s Post-hoc tests and Independent sample t-test. A survey of all the journals that were related to the field of orthodontics was performed in various databases. Journals that are included in the DCI categories were listed and colour-coded. Results: Majority of study participants in this study were professors (53.3%) followed by readers and senior lecturers (15.9% each). Significant differences (p-value=0.021) were noted in participants’ knowledge on the DCI points system based on designation. Almost all the respondents reported indexing of the journal to be the basis for selecting a journal. Only 8.4% responded that, they were not aware of the DCI’s points system for publications. Subjects with self-reported awareness on the DCI points system showed a significantly higher mean knowledge score compared to their counterparts. Conclusion: Subjects with self-reported awareness on the DCI points system showed a significantly higher mean (2.412±0.793) knowledge score compared to their counterparts. A colour-coded guide was developed to eliminate the bias in point calculation completely and help academicians select a journal suitable for academic promotions.

Epidemiological and Clinical Pattern of Leprosy in a Tertiary Care Centre in Bareilly, Uttar Pradesh, India- A Retrospective Study

Naveen Netaji Rao

Introduction: Leprosy also known as Hansen’s Disease (HD), is a chronic infectious granulomatous disease caused by Mycobacterium leprae. It affects the skin and peripheral nerves. It is characterised by the formation of nodules or macules that enlarge and spread with loss of sensation due to nerve involvement which can progress to paralysis and eventually lead to deformities. Aim: To describe the clinical and epidemiological pattern of leprosy patients in a tertiary care hospital in Bareilly, Uttar Pradesh, India. Materials and Methods: This retrospective study was conducted at a tertiary level, Military Hospital in Bareilly, Uttar Pradesh, India, from June 2022 to August 2022. Medical records of 263 Leprosy patients, who were diagnosed as HD clinically and histopathologically were part of the study. All their data pertaining to the history, onset, time of detection, clinical features in the form, type and number of patches, presence of peripheral nerve thickenings, investigations which included skin slit smear for Acid Fast Bacilli (AFB) (Lepra) and histo-pathological examination, duration of drug therapy, reactions encountered and the disabilities were collected. The data was compiled in Microsoft (MS) Excel format anfd analysed. Results: A total of 263 case records of leprosy patients (225 males (85.55%) and 38 females (14.45%), mean age of 35.36±13.79 years) were analysed. Majority of the cases were Borderline Tuberculoid (BT) Hansen’s 113 (42.96%). Average time taken by the patients before reporting to the Leprosy centre from onset of symptoms was 18 months. The most common clinical manifestation was multiple light coloured numb patches in 169 patients. A total of 245 patients had peripheral nerve thickening with Ulnar nerve 205 (77.95%) being the most commonly affected nerve. A total of 98 patients had Type-1 reaction and 13 had Type-2 reaction. The Grade-2 disability was seen in 22 cases with claw hand deformity being the commonest 10 (45.45%). Conclusion: In present study, majority patients were male with the most common clinical manifestation being multiple numb patches all over the body. The most common type of leprosy which presented was BT HD.

CT Severity Score in COVID-19 Patients and its Association with Diabetes Mellitus and Hypertension: A Retrospective Study

Harshit Kumar Koshta, Akshara Gupta, Sanjay Dhawale

Introduction: The Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China, in December 2019. It is thought that, people who have Diabetes Mellitus (DM) and Hypertension (HTN) are more likely to get a severe COVID-19 infection. High-resolution Chest Computed Tomography (HRCT) has been shown to provide immediate results with high sensitivity and specificity for determining the severity of COVID-19 infection and lung involvement. Aim: To determine the association between chest CT Severity Scores (CTSS) and DM and HTN in COVID-19 patients. Materials and Methods: This retrospective observational study was conducted in the Department of Radiodiagnosis at, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India. The duration of the study was one month, from July 2020 to August 2020. Based on the degree of lung involvement seen on HRCT chest scans. A total of 100 patients (68 males and 32 females) with COVID-19 infection were given a quantitative CTSS. The patients were divided into groups with mild, moderate, and severe lung involvement based on the CTSS. The Chi-square test was used to assess the relationship between DM, HTN, and CTSS. The data was analysed using Statistical Package for Social Sciences (SPSS) version 17.0. Results: The mean age of study participants was 45.7±15.95 years. A total of 72 (72%) of the participants were of normal weight, 8 (8%) were overweight or obese, and 20 (20%) were underweight. COVID-19 patients with a co-diagnosis of DM (61.9%) or HTN (69.2%) had more severe lung involvement than COVID-19 patients without DM (19%) or HTN (21%). DM and HTN were found to be significantly associated with severe lung involvement (p-value <0.01). Conclusion: Diabetic and hypertensive patients are more likely than non diabetic and non hypertensive patients to develop the severe form of COVID-19 and have a higher CT lung involvement score. DM and HTN should be considered as risk factors for the severity of COVID-19 disease.

Comparison of Intubating Conditions of Two Doses of Rocuronium Bromide with Succinylcholine in Children undergoing Elective Surgeries under General Anaesthesia- A Randomised Control Trial

Maitri Patel, Vijay Chandak, Aruna Chandak, Nitin Alaspurkar, Kashyap Kanani

Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted side-effects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, double-blinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. Group-R9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), Chi-square test, and Analysis of Variance (ANOVA), test where the difference was considered statistically significant if the p-value <0.05 by using the software Statistical Package for the Social Sciences version 11.0 (SPSS version 11.0). Results: Rocuronium bromide 1.2 mg/kg and succinylcholine 1.5 mg/kg provided excellent intubating conditions in 96.7% children and good intubating conditions in 3.3% children in both groups, while rocuronium bromide 0.9 mg/kg provided excellent intubation conditions in 83.3% of children and good intubating conditions in 16.7% of children There was a significant difference present in intubation scores between three groups (p=0.01). The duration of action was longer with rocuronium bromide 1.2 mg/kg (38.93±4.323 minute) as compared to rocuronium bromide 0.9 mg/kg (26.07±2.791 minute) while it was shortest with succinylcholine 1.5 mg/kg (6.00±1.74 minute). Adverse effects like fasciculations were only found in children (n=30) receiving succinylcholine (p=0.01) but not in rocuronium bromide groups. Conclusion: Rocuronium bromide 1.2 mg/kg gives the same intubating conditions as succinylcholine 1.5 mg/kg with good haemodynamic stability and no side-effects but the duration of action was longer with rocuronium bromide 1.2 mg/kg as compared to rocuronium bromide 0.9 mg/kg. So, to avoid unwanted side-effects of succinylcholine in children, rocuronium bromide 1.2 mg/kg can be used as an alternative to succinylcholine 1.5 mg/kg in children undergoing elective surgeries where early return of spontaneous recovery is not needed.

Quality Assessment of Hand Hygiene and Effectiveness of WHO 6 Step Training among Healthcare Personnel in a Tertiary Care Cancer Hospital in Trivandrum, India: A Cross-sectional Study

Introduction: World Health Organisation (WHO) 6 steps for effective Hand Hygiene (HH) practice to prevent cross infections emphasises on coverage of all aspects of the hand with the Alcohol Based Hand Rub (ABHR). The quality of hand rubbing usually remains un-monitored among healthcare workers. Hence, interventions to ensure both compliance and quality combined with periodic training would fill the deficiency in these practices in the healthcare setting. Aim: To analyse the quality of HH using an Ultraviolet (UV) sensitive ABHR among healthcare workers in the Operation Theatre (OT) and post-surgical Intensive Care Unit (ICU). Materials and Methods: This cross-sectional study was conducted in Regional Cancer Centre, Trivandrum, Kerala, India. Study population included 104 healthcare providers in the OT and post-surgical ICU, over a period of two months, from June 2017 to July 2017. Participants were asked to disinfect their hands according to WHO 6 steps using an ABHR to which an UV light sensitive pigment was added, and then place them in an UV light sensitive cabinet. Digital images of both sides of their hands were recorded. Every area of the hand not covered by the hand rub appeared as a dark spot and was considered an error. Pass criteria allowed a maximum of two small uncovered areas (dark spots <0.6 cm2) on the dorsal side of the hand and no uncovered areas on the palmar aspect. Each hand was observed specifically at four areas and the most missed areas were identified. Statistical analysis was done by Fisher’s-exact test using Statistical Package for Social Sciences (SPSS) version 28.0. Results: Out of the total 104 participants, 28 were doctors, 46 were nurses, 22 were nursing students and 8 were OT technicians. A total of 65 (62%) participants were males and 85 (82%) participants were in the 35-40 years age group. The HH was found to be better on the right hand in all the sub-groups studied. The difference in the hand rub coverage on all the four observed areas of the right hand was not significant. On the left-side, hygiene in between the fingers (p-value 0.012) and at the finger tips (p-value 0.007) was poorest. Among the groups studied, doctors performed better with a higher group score of 60.7% compared to 22.7% of that of nursing students (p-value 0.030). Conclusion: Quality of HH practice using ABHR among personnel involved in perioperative care is poor and requires improvement with regular monitoring and training.

Cervical Length Measurement at Term Pregnancy as a Predictor of Time of Onset of Labour and Mode of Delivery: A Longitudinal Study

Shanmugapriya Chandrasekaran, J Karthiga Prabhu, A Senthilvadivu

Introduction: Cervical assessment has moved from digital examination to sonographic evaluation in recent years. Predicting the time of onset of labour and mode of delivery at term is a great concern for both the pregnant woman and her relatives. Aim: To predict the time of onset of labour and mode of delivery by Transvaginal sonographic measurement of cervical length at term. Materials and Methods: This longitudinal study was conducted in the Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, Kattankalathur, Tamil Nadu, India, from March 2021 to August 2021. All low-risk singleton pregnancies between 38-40 weeks of gestation were included. Cervical length (in mm) was measured transvaginally by the principal investigator between 38 and 40 weeks. When the labour sets in the duration between cervical length measurement and the onset of labour, duration of labour and mode of delivery were noted. Pearson correlation coefficient was used to quantify the association between cervical length and time of onset of labour and duration of labour. Results: In the study, 164 low-risk patients (143 primigravida patients+21 multigravida patients) between 38-40 weeks were included. In patients with spontaneous onset of labour, 45 (70.3%) had labour onset within 120 hours (five days) when cervical length was ≤30 mm, when compared with 7 (22.58%) when cervical length was >30 mm (p=0.001). In patients with cervical length ≤30 mm, vaginal delivery occurred in 47 (73.43%) (p=0.019). In women with induced labour with cervical length ≤30 mm, 13 (61.9%) had labour onset within 120 hours when compared to 15 (30.6%) in women with cervical length >30 mm (p=0.02). Vaginal delivery occurred in 5 (29.41%) of women when cervical length was ≤30 mm compared to 32 (65.30) in women when cervical length >30 mm which may be attributed to other causes. There was a significant positive correlation between cervical length and time of onset of labour (correlation coefficient=0.221, p-value=0.004). There was a negative correlation between cervical length and duration of labour which was not statistically significant (correlation coefficient=-0.108, p=0.25). There was no significant difference in mean cervical length measurement between vaginal delivery and caesarean section. Conclusion: Transvaginal cervical length measurement at term positively correlates with time of onset of labour but not with duration of labour and mode of delivery.

Role of C-reactive Protein and Mean Platelet Volume in Predicting COPD Severity and its Association with Cardiac Abnormalities among the Southern Indian Population: A Cross-sectional Study

Suresh Sagadevan, Radhika Sharma, Aruna Shanmuganathan, Meenakshi Narasimhan

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality worldwide. In individuals with mild-to-moderate COPD, serum C-reactive Protein (CRP) corresponds with disease severity and poor health outcomes. Mean Platelet Volume (MPV) is also linked to an elevated degree of inflammation in the body, as well as the severity and acute exacerbation of COPD. Aim: To evaluate the relationship between serum CRP levels and MPV and its association with COPD severity and the patient’s cardiac abnormality. Materials and Methods: A cross-sectional study was conducted in the Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, between January 2015 and January 2016. Study was carried out among 55 patients who were diagnosed with COPD in accordance with Global Initiative for Chronic Obstructive Lung Disease 2014 (GOLD) and who were within the age range of 40-70 years were included in the investigation. Severity of airflow obstruction was confirmed by Spirometry using True Flow Easy on PC sensor Pulmonary Function Test (PFT) machine with bronchodilator reversibility testing, as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2014 and abnormality was evaluated by clinical and radiological assessment. A 3 mL of blood was collected into a clot vial and sent for analysis of CRP using an immunoassay system based on antigen-antibody reaction and fluorescence technology and MPV using the impedance count technique. Receiver Operating Characteristic (ROC) curve was used to find out the sensitivity and specificity of MPV and CRP levels with cardiac abnormality. The study was statistically analysed by Pearson’s Chi-square test. Results: Out of total sample, majority (n=25, 45.5%) were between 51-60 years age group and, there were 35 (63.63%) males and 20 (36.37%) females. The mean CRP levels of mild COPD patients were found to be 6.980±0.7328 mg/dL, moderate and severe COPD patients were found to be 7.243±0.5324 mg/dL and 7.550±0.4950 mg/dL, respectively and it was statistically significant (p-value <0.0001). In the present study, the mean CRP levels and mean MPV were found to be significantly higher in patients with cardiac abnormality than the patients without cardiac abnormality (p-value <0.0001). Conclusion: Finally, it was concluded that systemic inflammation is common in COPD patients and that CRP and MPV are significant COPD biomarkers for assessing disease severity, predicting cardiac abnormalities, and predicting patient prognosis.

Minimal Surveillance of MRSA in a Highly Polluted Region: A Cross-sectional Study on Prevalence in National Capital Region, India

Prachee Singh

Introduction: In India, Methicillin Resistant Staphylococcus aureus (MRSA) causes both community infection as well as hospital acquired infection. The infection mostly is endemic in nature. Aim: To find out the prevalence of MRSA in the NCR region, India. Materials and Methods: The present study was a cross-sectional analysis in which 653 samples were screened for MRSA in the laboratory. Isolates were tested against cefoxitin using disk diffusion method from October 2022 to December 2022 in Department of Microbiology, Rama Medical College, Hospital and Research Centre Hapur, National Capital Region (NCR), India. A total of 46 isolates were found to be MRSA positive. All 46 specimens of MRSA were put to test for Antimicrobial testing to know the susceptibility of antibiotic individually. All positive specimens were segregated based on gender, type of specimen, indoor verses outdoor patients. The data of the study was analysed by excel software on different parameters as per objectives of the study. Results: The positive MRSA specimens were 46 (7.04%) out of 653 different category of specimens tested. More positivity (8.56%) was recorded in female patients than 5.52% in male patients. The share of male positive was 39.13% and for female, the share among positive sample was 60.87%. Among male positive samples, 7.96% samples (maximum) were from 21-40 years age. The female patients above the age of 60 years had maximum (15.78%) share of positive cases. Inpatient Department (IPD) recorded more (54.35%) of MRSA positive cases. Vancomycin showed highest susceptibility (97.82%) to MRSA. The lowest susceptibility (4.34%) was shown by erythromycin. Conclusion: This study establishes only 7.04% MRSA which was found on lower side comparing the average ratio of Delhi and Uttar Pradesh and perhaps the lowest in the country according to various studies carried out across India. Region-wise epidemiological study of MRSA is required periodically. The MRSA infection can be controlled by preventing its spread and minimising the emergence of drug resistance by following a robust antimicrobial stewardship.

Clinical Profile of Squamosal Chronic Otitis Media among Paediatric and Adult Patients in Rural Population of Central India: A Cross-sectional Study

Aishwarya Vijayappan, Prasad T Deshmukh, Sagar Gaurkar

Introduction: Chronic Otitis Media (COM) is one of the major preventable causes of hearing impairment, especially in children. Hearing loss in children affects speech, language, communication, auditory processing, psychosocial and cognitive development, and academic progress. Since studies addressing and comparing COM in the paediatric and adult population are few and far between, present study attempted to fill this research hiatus. Aim: To analyse and compare the clinical profile of squamosal COM in paediatric and adult populations. Materials and Methods: The present cross-sectional study was carried out in the Department of Otorhinolaryngology, Acharya Vinod Bhave Hospital, Sawangi, Wardha, Maharashtra, India, from December 2020 to December 2022. All the selected patients with squamosal COM (active or inactive) in the paediatric age group (0-15 years) and adult age group (16-60 years) was considered in this study. The study included patients (12 patients in adult age group and 14 patients in paediatric age group) and was evaluated based on intraoperative and radiological findings such as grades of retraction pocket, extent of ossicular erosion, extent, and spread of granulation and cholesteatoma, and pneumatisation pattern among both age groups were carefully analysed. Chi-square test (χ2) of independence was used to compare data between the two groups. A p-value ≤0.05 was considered statistically significant. Results: Erosion of scutum was predominantly noted in 6 (42.9%) paediatric patients. In both age groups, attic perforation were more common than marginal perforation, which was found to be statistically significant (p-value=0.045). Grade 2 Posterosuperior Retraction Pocket (PSRP) in paediatric (2, 14.2%) and Grade 4 PSRP in adults (4, 33.3%) were commonest whereas none of the paediatric patients showed Grade 4 PSRP. This difference in PSRP grade in both age groups was found statistically significant (p-value=0.038). Short process of incus was more frequently involved in 3 (25.0%) paediatric and long process of incus in 6 (60%) adult (p-value=0.040). There was frequent involvement of protympanum in 7 (50%) paediatric patients (p-value=0.035). Diploic pattern of pneumatisation was least common in both age groups. Conclusion: Greater grades of PSRP were found among adult patients. This might be contributed to the longer duration of exposure to disease pathogenesis in adults. One of the vital features in the ossicular involvement is the total absence of incus and malleus more frequently in paediatric patients indicating its extensiveness.

Evaluation of Spinopelvic Parameters in Patients with Different Grades of Intervertebral Disc Degeneration in Lumbosacral Spine vs Normal Asymptomatic Population: A Retrospective Observational Study

Introduction: Spinopelvic malalignment causes continual backache. Intervertebral Disc Degeneration (IDD) is a leading cause of low backache. Understanding the relationship between spinopelvic parameters and IDD can help with better diagnosis and treatment and avoid unnecessary investigations. Aim: To measure radiographic spinopelvic parameters of patients diagnosed with varying grades of IDD in the lumbosacral spine on Magnetic Resonance Imaging (MRI), and to compare them with radiographs of the asymptomatic population (controls). Materials and Methods: A hospital-based retrospective observational study was conducted in Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India from January 2021 to August 2022. A total of 80 patients diagnosed with IDD on MRI and 80 controls. Cases were defined as patients diagnosed to have IDD on MRI and controls were those individuals who did not have disc degeneration on MRI. Lateral lumbosacral spine radiographs were taken, and spinopelvic parameters {Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), lumbo-sacral angle, and sacral horizontal angle} were measured using Surgimap Spine Software. T-test and Chi-square test were applied for comparison between cases and controls. Results: Six patients had asymmetric disc bulge, 11 had symmetric disc bulge, 18 had disc extrusion and 45 had disc protrusion. Mean PT in patients with IDD was 11.05±3.84°, and control was 8.65±3.19°, p-value=0.009. Mean SS in case group was 38.38±3.03° and control was 36.56±3.43°, p-value=0.031. The mean PI of cases was 49.44±8.39° and control 46.19±9.01°, p-value=0.02. LL angle was higher in IDD at 46.34°, and was 45.36° in healthy individuals, without statistically significant difference. The mean lumbosacral angle in both study groups was similar. The mean Sacral Inclination Angle (SIA) was found to be 43.99° and 44.96° in the case and control group respectively without showing significant differences. A statistically significant difference was found only for the comparison of PT between different grades of IDD (p-value=0.039). Conclusion: Using Surgimap Spine Software, one can predict the individuals that possess a greater propensity of developing degeneration of disc and chronic low back pain in a more cost-effective manner.

Non Narcotic Pain Relief in Postcaesarean Women by Percutaneous Stimulation of Auricular Pressure Points: A Randomised Controlled Study

Lakshmi Prakash, Mangal Swathi Venkataraman, Basker Natarajan

Introduction: Caesarean sections are the most common surgeries performed globally now-a-days. The postoperative period is associated with immense pain which if not mitigated can be detrimental to both mother and baby. An inadequate analgesia can lead to postpartum depression, and can also affect mother-baby bonding, breastfeeding including delay in ambulation. Aim: To assess the efficacy of non narcotic pain relief and to study the additional need of rescue analgesics. Materials and Methods: A randomised controlled study was carried out at the Institute of Social Obstetrics and Government Kasturba Gandhi Hospital Chennai, Tamil Nadu, India for a duration of three months between May 2022 to July 2022 after registering with Clinical Trials Registry-India CTRI/2022/04/041633. A total of 60 antenatal women undergoing caesarean section under spinal anaesthesia were randomly allocated into two groups of 30 each. Group P received stimulation of auricular pressure points with a stimulation device at the end of caesarean procedure and Group C was a control group. The cases were monitored for 48 hours, and the following parameters were recorded: spinal regression time, pain score Visual Analogue Scale (VAS), rescue analgesic need including time and total dosage, sedation scores using the modified Ramsay sedation scale and postoperative nausea and vomiting. Data analysis was done using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 23.0. Data was expressed as mean±Standard Deviation (SD). Quantitative analysis was done using Pearson’s Chi-square test and Independent t-test. A p-value of <0.05 was considered significant. Results: Group P had VAS scores 2.53±0.64 and Group C had VAS scores 4.97±0.47 with highly significant p-value of <0.001. Only 2 (7%) of patients in Group P needed rescue analgesic whereas all patients of Group C required rescue analgesic with highly significant p-value of 0.001. Postoperative nausea vomiting was noted in only 1 (3%) patient of Group P as opposed to 12 patients (40%) in Group C with highly significant p-value <0.001. Group P showed maximum sedation score of two as compared to three in Group C as assessed by Modified Ramsay Sedation scale with statistically significant p-value of 0.01. Conclusion: The percutaneous stimulation of auricular pressure points is efficacious in providing good analgesia with early ambulation, breastfeeding, and no adverse effects.

Comparison of Endotracheal Intubation through ILMA and Baska Mask: A Randomised Clinical Study

Introduction: Supraglottic Airway Devices (SADs) have established a role in both routine as well as emergency airway management of difficult airways in both children and adults. But anaesthesiologist may need to secure the airway by inserting an Endotracheal Tube (ETT) at any time. Aim: To evaluate success rate of Baska mask and Intubating Laryngeal Mask Airway (ILMA) for ETT insertion through them by conducting a prospective and randomised study. Materials and Methods: The randomised clinical study was conducted in 60 American Society of Anaesthesiologists (ASA) status I-II patients scheduled for elective surgical procedures requiring endotracheal intubation through either Baska mask or ILMA. In both the groups, standard induction and insertion technique of SAD was used. Reinforced ETT was used in the first attempt and Polyvinyl Chloride (PVC) ETT in the second attempt for intubation through both SADs. The total time for intubation, number of attempts taken to insert the SAD and ETT through it, haemodynamic response and adverse events were studied. Data was analysed using Statistical Package for the Social Science (SPSS) version 21.0. Results: Patients in both the groups were comparable demographically with respect to sex, as a status, age and weight. Successful intubation was achieved in 33.3% (n=10/30) on first attempt through Baska mask compared to 86.7% in ILMA (n=26/30) (p=0.001). The overall intubation success rate was also lower with Baska group (56.7%; n=20/30) compared to ILMA (100%; n=30/30) (p<0.001). The haemodynamic parameters during intubation were also significantly higher in the Baska group as compared to the ILMA group. There were no differences in the other secondary outcomes. Conclusion: The first pass and overall success rate of intubation through the Baska mask were inferior to those of ILMA.

Comparative Evaluation of Antibacterial Efficacy of Two Bioceramic Root Canal Sealers Incorporated with Novel Silica Doped TiO₂ Nanoparticles: An In-vitro Study

Alekhya Mediboyina, Krishna Prasad Parvathaneni, TBVG Raju

Introduction: The success of Root Canal Treatment (RCT), depends on the complete elimination of microorganisms in combination with complete root canal system closure. Complete elimination of bacteria cannot be done by cleaning and shaping alone from lateral canals, isthmuses, and apical deltas. Thus, root canal sealers with ideal physical, biological, and improved antimicrobial characteristics are thus, necessary to avoid reinfections. Aim: To evaluate the antibacterial efficacy of two Bioceramic (Bio-C) modified root canal sealers, using Silica Doped Titanium Dioxide Nanoparticles (SiTiO2), a unique, extremely effective antibacterial agent on root canal dentin infected with Enterococcus faecalis (E. faecalis). Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics in collaboration with the Department of Microbiology at Sree Sai Dental College and Research Institute, Andhra Pradesh, India. The study was done in August 2022. The antibacterial efficacy of the two Bio-C sealers was evaluated by counting Colony Forming Units (CFU) and the percentage of live bacteria by a confocal laser scanning microscope. A total of 60 middle thirds of single-rooted teeth incubated with E. faecalis were chosen. Gutta-percha (GP) was used to fill the canals along with sealers in all six groups (group I-VI), namely Mineral Trioxide Aggregate based (MTA Fillapex); MTA Fillapex+SiTiO2 NPs (1% wt); MTA Fillapex +2% wt SiTiO2 NPs; Bio-C; Bio-C+ 1% wt SiTiO2 NPs; Bio-C+ 2% wt SiTiO2 Nanoparticles (NPs), respectively and incubated for seven days, each tooth was divided into two halves longitudinally. Microbiological analysis was conducted on one half, and microscopic analysis on the other half. The six groups were compared using a one-way Analysis of Variance (ANOVA) and intergroup comparison with Tukey’s post-hoc tests. Results: The addition of SiTiO2 NPs to Bio-C and MTA Fillapex significantly reduced the bacteria, compared to an unmodified sealer (p-value <0.001). MTA Fillapex with SiTiO2 NPs showed higher bacterial viability compared with Bio-C with SiTiO2 NPs. Conclusion: Loading endodontic sealers with SiTiO2 NPs has a material-dependent impact on the antibacterial properties, that could lower the frequency of secondary infections.

Content Validity and Test-retest Reliability of Self-reported Questionnaire Assessing Knowledge and Perception of SMS Thumb: A Cross-sectional Study

Shreeraksha L Naik, Saumya Srivastava

Introduction: Continuous texting is associated with more stress on the thumb, which may cause the onset of a variety of wrist and thumb conditions. Today’s youth spend the majority of their time on smartphones, which might cause texting thumb symptoms to occur. As there is a lack of a questionnaire that can evaluate their awareness and views, this was the first study that develops as well as evaluates the validity and reliability of a self-designed questionnaire. Aim: To assess the validity and reliability of a self-designed questionnaire that measured knowledge and perception of Short Message Service (SMS) Thumb. Materials and Methods: This cross-sectional pilot survey was conducted in Mangalore, Karnataka, India from June 2022 to July 2022. Validity and reliability were performed in two sections. A panel of four experts reviewed the questionnaire’s content validity to determine its Content Validity Index (CVI), while reliability was performed by using test-retest reliability method which was carried out through an online survey among 31 young individuals with the inclusion criteria of non medical students aged between 18-25 years. CVI was used to analyse the questionnaire’s validity. Test-retest statistical analysis was performed by Statistical Package for the Social Sciences (SPSS Inc; Chicago, IL), Version 26.0 and internal consistency were used to assess the reliability. Pearson correlation was used to perform the reliability. Results: The item Content Validity Index (i-CVI) of the questionnaire was 1.00 for 20 of the 25 questions, while the average scale CVI of the questionnaire was 0.95. Test-retest reliability and internal consistency were both evaluated using Cronbach’s alpha coefficient and Pearson’s correlation ratio, respectively. The questionnaire was significantly reliable with a p-value <0.05. Conclusion: The questionnaire showed acceptable test-retest reliability and content validity which can be a useful tool for measuring awareness and attitude about SMS Thumb.

Comparison of Cord Blood pH, Haematological Parameters and APGAR Score of New-Born with Maternal and Peri-Natal Risk Factors: A Prospective Observational Study

Introduction: Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score is used worldwide to assess newborn health immediately after birth. The combination of pH analysis, haematological parameters of cord blood samples and APGAR score compared with the maternal and peri-natal risk factors will help us identify the cause of low APGAR. Aim: To compare the pH of cord blood, haematological parameters, Neutrophil-Lymphocyte Ratio (NLR) and APGAR score with high-risk maternal and peri-natal factors. Materials and Methods: This is a prospective observational study, conducted over a period of six months, at Chettinad Hospital and Research Institute, Chennai. The cord blood samples of 40 newborns (20 normal and 20 high-risk pregnancy) were collected for assessing pH and haematological parameters (complete haemogram, nucleated Red Blood Cells (RBCs), reticulocyte count). APGAR scores were obtained from clinical records. The data obtained in the study was analysed using the International Business Management (IBM) Statistical Package for Social Sciences (SPSS) statistics version 23.0. Results: The authors compared 20 cases of newborns with maternal risk-factors with 20 newborns with no risk factors, and found that low APGAR and acidic pH of cord blood, high NLR was associated with risk factors present in the ante-natal and peri-natal period. Conclusion: The present study observed that a low APGAR, low acidic pH of cord blood, high NLR was seen in mothers with adverse risk factors during pregnancy, compared to the mothers with no associated co-morbidities. Hence, the presence of risk-factors during pregnancy should warrant a close follow-up of the new-born in the immediate postpartum period.

Evaluation of Triple Drug Administration for Lymphatic Filariasis in Prayagraj District, Uttar Pradesh, India: A Cross-sectional Study

Khurshid Parveen, Lal Divakar Singh

Introduction: Unplanned urbanisation and improper sanitary system in many cities in a developing country increase the cases of vector borne diseases. Among these, filariasis is a major health problem in India. Campaign for triple drug therapy to eliminate the lymphatic filariasis was launched by Government of India but, data assessing the Mass Drug Administration (MDA) coverage and compliance is scarce. Aim: To assess coverage and compliance of triple drug administration for Lymphatic Filariasis (LF) in Prayagraj district. Materials and Methods: This community based cross-sectional study was conducted in the Department of Community Medicine at Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India. The duration of the study was 8 days, from 30th October 2021 to 6th November 2021. A total of 1739 individuals belonging to rural and urban area of district Prayagraj were included in the study. Systematic selection was used for selection of subunit. Random selection of 30 subunits from the survey area was done and also Probability Proportional to Estimate Size (PPES) was used, sampling to give everyone in the survey population an equal probability of being selected. A segment of households were randomly selected (typically-10 household) from each subunit (30 subunits, e.g., village). The number and percentage of characteristics were calculated. The data has been entered in MS Excel and analysis was done using Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the study participants were 30.78±18.18 years for males and 30.04±17.48 years for females. A total of 1739 persons were covered in post MDA coverage evaluation survey out of which, 1361 persons belonged to rural area and 378 persons belonged to urban area. Ivermectin, albendazole and Diethylcarbamazine (DEC) were swallowed more in urban area (53.27% for each drug) as compared to rural area (18.25% for each drug). Overall, estimated 45.66% drugs were swallowed in district Prayagraj. Adverse drug effect was not found. Conclusion: The overall coverage of mass drug administration was low (45.66%) and far behind the national target of >85% and it was even worse in urban area where only one-third of the population were offered mass drug administration.

Revised Trauma Score, Injury Severity Score, New Injury Severity Score and Trauma Revised Injury Severity Score among Trauma Patients in a Tertiary Care Hospital: A Comparative Study

K Srinidhi, R Jai Vinod Kumar, M Reegan Jose

Introduction: Injury severity scoring can provide objective correlations with resource utilisation, such as length of stay and treatment costs, and inform clinical decisions regarding managing injuries of specific severity. The ability to predict survival after trauma is perhaps the most fundamental use of injury severity scoring. Aim: To compare the efficacy of the Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma Revised Injury Severity Score (TRISS) in the prediction of mortality in trauma patients. Materials and Methods: The present prospective observational study was conducted in the Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India from April 2021 to September 2022 in 400 trauma patients who were clinically assessed and managed as per the latest Advanced Trauma Life Support (ATLS) guidelines (10th edition). After the stabilisation of the patient, RTS, ISS, NISS and TRISS were obtained from the trauma chart, imaging studies and intraoperative findings. Statistical analysis was done using the statistical software Statistical Package for the Social Sciences (SPSS) version 16.0. Results: Most trauma patients showed more blunt injuries 284 (71.0%) than penetrating injuries 116 (29.0%). The major trauma region was external 161 (40.3%), followed by extremity 124 (31.0%). The mortality rate in the present study was 17 (4.3%). The cut-off points for predicting mortality in trauma patients in ISS, RTS, NISS and TRISS systems were 22, 6.8, 28.5, 87.95 with sensitivity of 94.12%, 88.24%, 88.24%, 100.00% and specificity of 94.78%, 94.52%, 92.95%, 95.56%, respectively. Conclusion: According to the current study’s findings, TRISS was a more accurate prognosticator among trauma patients.

Comparison of Stress Levels with Online and Offline Mode of Teaching in Medical Undergraduate Students during COVID-19 Pandemic: A Cross-sectional Study

LM Sweety, S Shalini, C Beyaril Chitra

Introduction: Medical education in India being stressful, precipitated further due to the outbreak of Coronavirus Disease- 2019 (COVID-19) and hence shifting to the online mode of education. The sudden implementation of online teaching learning methods, lack of communication between teachers and students and further the tedious modes of assessments through online methods created chaos among the students subjecting the students under enormous stress. Aim: To compare the stress levels in online and offline mode of teaching in medical undergraduate students. Materials and Methods: The study was designed as a cross-sectional observational study. It was conducted in two Government Medical Colleges located in Kanyakumari and Thiruvananmalai of Tamil Nadu, India during April 2021 to December 2021 after the students returned to the conventional teaching method from digital learning (during COVID-19). This study assesses the stress by using Perceived Stress Scale, among young healthy individuals (390 medical graduates of either sex) who were in their preclinical, paraclinical and clinical years of the medical curriculum. The questionnaire comprised of general demographic data and consent form (six items) information on online classes and offline classes (18 items) and Perceived Stress Scale- 10 questionnaire to assess stress during online and offline mode. The obtained results were tabulated and was statistically analysed by Pearson Chi-square test. Using the software R (Programming Language) version 2021 for used for anlaysis. Results: Out of the 390 students participated in the study 204 (52.30%) of the students were from Government Kanyakumari Medical College, with 98 (48.04%) male and 106 (51.96%) female students. While the remaining 186 (47.70%) students were from Government Thiruvannamalai Medical College, with 84 (45.17%) male and 102 (54.83%) were female students. The mean age of the participating students were 19.6±2.4 years. The difference in the number of scheduled hours of classes, duration of each classes were more during offline classes compared to online classes. Whereas the attention span of the students were more during offline classes of >30 minutes compared to online classes with attention span of <20 minutes, in most of the students. Further the study revealed that online mode of teaching was highly stressful to the students compared to offline teaching which was moderately stressful (highly significant), further the students experienced other adverse effects related to stress such us deterioration of vision, lack of concentration, difficulty in sleep etc. Conclusion: The study emphasises that irrespective of the mode of teaching, medical undergraduate students experience stress under any form, however online mode of teaching is much more stressful than offline teaching.

Evaluation of Community Pharmacists’ Awareness towards Middle East Respiratory Syndrome: A Simulated Client Method

Introduction: Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a coronavirus variant in the Arabian Peninsula. There is a lack of information regarding awareness and practices of community pharmacists in Qatar for this contagious disease. Aim: To determine the quality of the MERS-related information, recommendations, and counselling practices provided by Qatar’s community pharmacists by using Simulated Client Method (SCM). Materials and Methods: An observational cross-sectional study using a non traditional SCM was conducted in community pharmacies of Qatar from February 2017 to April 2017. A total of 30 community pharmacies were visited twice by two independent simulated clients and data regarding, provision of evidence-based information, recommendations and counselling practices were collected to assess the competency of pharmacists in managing MERS as a primary care problem. Both descriptive and inferential statistical methods were used for data analysis. Results: In present study, majority of pharmacists encountered were male and younger than 45-year-old with 44 (73.3%) each. The average number of pharmacists who did not ask about the patient’s current medical conditions 56 (93.3), medications 58 (97.5%), allergies, and smoking status in both scenarios were not asked by any of the pharmacist. Most of the pharmacists gave an incorrect explanation of MERS 43 (71.7%). The overall quality counselling score for the pharmacists (mean±SD; median (IQR)) was {27.5±4.5; 28.5 (25.3-30.0)}. Quality counselling was significantly related to the type of pharmacy (p=0.0478). Conclusion: Qatar community pharmacist’s MERS related information, recommendations, and counselling practices were below expectations and inconsistent, thus urging the need for continuous professional development.

Morphometric Sex Identification Based on Paranasal Sinus Dimensions in the Indian Population: A CBCT Based Study

Jijin Mekkadath Jayakrishnan, Jagat Reddy, RB Vinod Kumar

Introduction: The creation of technologies using anatomical components like the maxillary sinus and frontal sinus that might preserve their stability yet after extreme events, are helpful for forensic investigations because sex determination is a crucial component of determining the profile of an individual. Aim: To determine the sex using Cone Beam Computed Tomography (CBCT) scans, in a South Indian community by measuring the frontal and maxillary sinuses. Materials and Methods: The present cross-sectional study was conducted in the Department of Oral Medicine and Radiology, Sri Balaji Vidyapeeth University, IGIDS, Puducherry, India, from 1st March 2021 to 31st March 2022. Analysis included 45 CBCT scans from 22 males and 23 females were subjected to volumetric measures in the maxillary sinus and frontal sinus. Applying NNT software, the volume measurement was carried out. The data was used to feed into a sex identification mathematical model. For evaluation, the student’s t-test has been used. Results: In the total study subjects, the mean age of males was 36.909 years and of females was 36.304 years. Only the volume of the frontal sinus varied significantly among males and females (p-value <0.001). The discriminant function analysis equation showed that 50% of males and 91.3% of females correctly identified their gender. According to the cross-validated categorisation, 71.1% of the people were accurately categorised altogether. Conclusion: Segregation identification, which was validated with evaluations in the frontal and maxillary sinuses with CBCT scans, is another technique for identifying individuals who identify as Indian. The present study shows that paranasal sinus morphologic evaluation is a useful method for identifying a person’s gender.

Adherence to Infection Control Measures and the Psychological Effects of Quarantine during COVID-19 Pandemic in Dibrugarh District of Assam, India: A Cross-sectional Study

Kavery Bora, Bitupan Kalita, Gourangie Gogoi

Introduction: Quarantine is an important means of controlling the spread of Coronavirus Disease-2019 (COVID-19) and it is essential to maintain strict adherence to infection control measures during this period. However, long periods of quarantine may be quite challenging by themselves especially in a pandemic of a new infection which might led to emotional, psychological and financial difficulties. Hence, understanding the psychological impact of COVID-19 on the quarantined people and how they have adhered to the infection control measures will help to formulate better prevention strategies. Aim: To assess the infection control measures among the people who were placed in quarantine and to understand its psychological effects during the COVID-19 pandemic in Dibrugarh District of Assam, India. Materials and Methods: This study was a community based cross-sectional study conducted among the people placed in quarantine in Dibrugarh District of Assam, India and was conducted from April 2020 to March 2021. During the COVID-19 pandemic, quarantine centres were set up in various educational institutions in the urban areas of Dibrugarh District of Assam. There were six such centres under the supervision of district health authorities. Taking three of these centres located at Chabua, Jokai and Lesai under Dibrugarh district, 159 quarantined subjects were enrolled for the study. Centre for Epidemiologic Studies Depression (CES-D) scale was applied for assessment of depressive symptoms and the post-traumatic stress symptoms were assessed using The Impact of Event Scale-Revised (IES-R). The adherence to infection control measures were assessed by using a predesigned, pretested questionnaire prepared for the purpose of the study, which was applied using online Google platform. Of the total 159 responses, 23 were incomplete and finally 136 were analysed. Descriptive analysis was done for the socio-demographic data. To find the association between quarantine and the psychological effects, Chi-square test was applied and p-value <0.05 was considered as significant. Results: Majority of the study subjects, 96 (70.59%) belonged to 10-29 years, 103 (75.74%) were males, and 126 (92.64%) were Hindu. About half of the participants were from urban area 72 (52.94%) and 48 (35.29%) were graduate. Majority of the participants 125 (91.91%) could manage to stay in separate room but arrangement of separate toilet was difficult. Similarly, about one-third 48 (35.29%) did not have a designated family member to look after them. Majority of the participants 135 (99.26%) practiced regular handwashing, wearing of mask 123 (90.44%) and regular disinfection of the items used by them 111 (81.62%). About 47 (34.56%) of the participants had sign and symptoms of post-traumatic stress, out of which females were affected more 14 (42.42%) and younger age group participants in the age range of 10 to 29 years 35 (36.46%) had more post-traumatic stress symptoms than the older adults. About one-third of participants 51 (37.5%) were depressed, 17 out of 33 females (51.52%) were found to be depressed and the younger age group in the age range of 10 to 29 years 42 (43.75%) were found to be more affected. Conclusion: Quarantine is an effective public health measure to control the spread of infection when people practice appropriate infection control measures. However, long periods of quarantine can cause psychological impact on the quarantined people which needs to be properly addressed.

Effects of Nalbuphine and Nefopam in the Management of Postoperative Shivering after Laparoscopic Cholecystectomy under General Anaesthesia: A Randomised Double-blind Study

Nahila Mahajan, Rajesh Angral, Anshuman Mahesh Chander, Raj Rishi Sharma

Introduction: Postoperative shivering is a very common and unpleasant complication of laparoscopic surgery under General Anaesthesia (GA). Postoperative shivering is uncomfortable for the patient, and it might increase the postoperative complications especially in high-risk patients. Aim: To compare the therapeutic effects of nalbuphine and nefopam in treating postoperative shivering in patients undergoing Laparoscopic Cholecystectomy (LC) under GA. Materials and Methods: The present study was a randomised, double-blinded, study conducted in the Department of Anaesthesiology and Surgery on 60 ASA Grade-I and II physical status scheduled for elective LC under GA, who developed postoperative shivering during recovery from GA, at Government Medical College and Hospital, Kathua, Jammu and Kashmir, India. A total of 60 patients aged between 25 to 60 years, American Society of Anaesthesiologists (ASA) I and II scheduled for elective LC under GA, who had postoperative shivering during recovery period. Study duration was of one year (October 2021 to October 2022). Patients were randomly allocated into group A (n=30, received nalbuphine) and group B (n=30, received nefopam). Data was collected and compiled using Statistical Package for the Social Sciences (SPSS) version 23.0. Student’s t-test and Chi-square test was used to analyse the data. The p-value <0.05 was considered as statistically significant. Results: Time for cessation of shivering was 4.11±1.12 minutes in nalbuphine group as compared to 3.03±0.68 minutes in nefopam group which was statistically significant (p=0.001). Response rate was 73.33% in nalbuphine group as compared to 90% in nefopam group, and the difference was statistically significant (p=0.043). Similar incidence of bradycardia and vomiting was noted in both the groups. Nausea (6.67% vs 3.33%), pain on injection (3.33% vs nil) and pruritis (6.67% vs nil) were more in nalbuphine group as compared to nefopam group which was statistically significant. Sedation was more in nalbuphine group as compared to nefopam group (10% vs 6.67%) which was not significant statistically. Conclusion: Nefopam as compared to nalbuphine had earlier cessation of shivering, better response rate and had less side-effects.

Morphological and Morphometric Variations in Foramen Transversarium: A Cross-sectional Study in Dried Cervical Vertebrae of Western Odisha Origin

Sarita Behera, Mamata Sar, Srikanta Kumar Mishra

Introduction: Foramen transversarium refers to bilateral foramina found lateral to the vertebral body in the transverse process of the cervical vertebrae. Many variations are observed in these foramina which may lead to vertebrobasilar insufficiency, labyrinthine or hearing disturbances along with neurological symptoms due to compression or tortuosity of vertebral artery as it passes through the foramen. Aim: To study the morphological and morphometric variations of the foramen transversarium in cervical vertebrae. Materials and Methods: This cross-sectional study was conducted in Department of Anatomy, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India, from June 2022 to August 2022. A total of 367 human cervical vertebrae were procured from the anthropology section of Department of Anatomy. Vertebrae with any damage to foramen transversarium were discarded. Each vertebra was observed for shape, size, symmetry, number of foramen transversarium and osteophytic encroachment. Distance of foramen transversarium from the medial margin of uncinate process was measured bilaterally in C3 to C7 vertebrae. Data collected was tabulated and analysed by Microsoft Excel software 2019. Results: Mean anteroposterior diameter and transverse diameter in left-side were 5.45 mm and 5.42 mm, respectively and in right-side the measurements were 5.29 mm and 5.23 mm, respectively. Double foramen transversarium was observed in 40 (10.9%) vertebrae. Among them 18 (4.9%) were bilateral and 22 (6.0%) were unilateral. In 2 (0.54%) vertebrae there was triplication of foramen transversarium. In 34 vertebrae (9.26%) there was incomplete duplication of which 9 (2.45%) were bilateral and 25 (6.81%) were unilateral. Six different shapes of foramen transversarium were observed out of which round shape (62.1%) was the most common finding. In 261 (71.1%) of vertebrae the main foramen transversarium was symmetrical in both sides but in 106 (28.9%) it was asymmetrical. Osteophytic encroachment was found in 14 (3.81%) vertebrae. The mean distance of the foramen from medial margin of uncinate process was 5.32 mm on the left and 5.42 mm on the right-side. Conclusion: The morphological data like very narrow foramina and such a high number of accessory foramina produced through the present study definitely points towards the variations of vertebral vessels.

Impact of Atorvastatin on C-reactive Protein, Glycaemic Status and Liver Enzymes among Non Diabetic Patients: A Prospective Study

Ramnarayan Maiti, Umakanta Mahapatra, Subhayan Das, Nabarun Mandal

Introduction: Atorvastatin is one of the common drugs used for primary and secondary prevention of atherosclerotic cardiovascular diseases. Various studies have suggested variation in C-Reactive Protein (CRP) value, glycaemic status and liver enzymes of patients following statin therapy. However, the adequate and exact data regarding the impact of atorvastatin on the above parameters in the population of Eastern India is still limited. Aim: To estimate the effect of atorvastatin on CRP, glycaemic status and haepatic enzymes of non diabetic patients. Materials and Methods: A prospective observational study was conducted in the Outpatient Department (OPD) of Internal Medicine at Midnapore Medical College and Hospital, Paschim Medinipur, West Bengal, India. The duration of the study was one year six months, from June 2020 to December 2021. A total of 150 non diabetic patients aged between 30-75 years receiving atorvastatin were enrolled in the present study. CRP, Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS), haepatic enzymes and lipid profile of participants were monitored at baseline, at the end of one month, six months and 12 months. The data was analysed using Statistical Package for Social Sciences (SPSS) version 22.0, Microsoft Excel and GraphPad Prism. Results: The study population was predominantly males (69.6%), with mean age of 54±8.88 years and mean weight of 60±5.86 kg. Majority of the patients were on atorvastatin 40 mg (60.86%) followed by atorvastatin 20 mg (26.8%) and atorvastatin 10 mg (12.3%). There were statistical significant changes of mean CRP (1.502 mg/L), mean FBS (86.52 mg/dL), mean PPBS (113.57 mg/dL), mean Serum Glutamic-Oxaloacetic Transaminase (SGOT) (22.84 IU/L), mean Serum Glutamic Pyruvic Transaminase (SGPT) (25.24 IU/L) and lipid profile levels at the end of one year. None of the patients developed new onset DM at the end of one year. A 5% of patients developed prediabetes at the end of 3rd follow-up. Conclusion: Atorvastatin usage showed that, there was a significant increase in blood glucose and haepatic enzymes level in non diabetic population. Hence, strict monitoring of blood glucose levels along with periodic monitoring of haepatic enzyme levels should be done in regular intervals.

Clinical Features of Post Fever Retinitis and Visual Outcomes with Oral Corticosteroids: A Retrospective Study

Sanjanashree S Patil, Vishalakshi, Charushila V Gejapati

Introduction: Post Fever Retinitis (PFR) is an infectious or parainfectious uveitis presenting with visual impairment after a fever episode. The condition can cause potential visual impairment in PFR patients. There is no national guideline for treatment of PFR. Hence, there is a need to study the clinical features and visual outcomes with the use of corticosteroid therapy. Aim: To describe the clinical features of patients presenting with PFR and visual outcome with the oral corticosteroid therapy. Materials and Methods: This retrospective study conducted in the Outpatient Department (OPD) of Ophthalmology at SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India. The duration of the study was 35 months, from January 2019 to December 2021. A total of 23 eyes of 13 patients treated with oral corticosteroids were included. Data collected included patients’ demographic details including name, age, sex, hospital identification number, duration of vision loss, detailed ophthalmic examination findings, including visual acuity testing with Snellen’s chart, slit lamp examination findings and fundus examination findings, including detailed fundus drawings, Optical Coherence Tomogram (OCT) and fundus photographs. Visual Acuity (VA) at the time of presentation and after steroid therapy were recorded. Data was entered in microsoft excel spreadsheet and descriptive analysis was done. Results: Age of the study participants ranged from 15 years to 52 years with an average of 29.6 years. A total of 23 eyes of 13 patients were included in the present study. At the time of presentation, two eyes had visual acuity better than 6/12 on Snellen’s chart. Five eyes had mild vision impairment, five eyes had moderate vision impairment and eleven eyes had vision <3/60, according to the visual impairment classification of World Health Organisation (WHO). Macular oedema was the other most common finding seen in 12 (52.17%) eyes. All the patients showed beginning of resolution of retinitis by 2-3 weeks after starting oral corticosteroids. A total of 23 eyes, 8 (34.7%) eyes recovered vision >6/12, out of which 6 (26.08%) eyes recovered with 6/6 vision. Conclusion: PFR affects predominantly young immunocomp-etent individuals. Treatment outcomes with oral steroids is found to be satisfactory.

Clinical Profile and Short-term Outcome of Paediatric COVID-19 in the First, Second and Third Wave of the Pandemic in India-An Observational Study

Sai Swaroop Archaka, Alexander Mannu, Vinoth Gnana Chellaiyan

Introduction: There has been adequate evidence that children are less likely to contract the Coronavirus Disease-2019 (COVID-19) infection and less likely to experience a deadly course of the disease in the paediatric group. The majority of the time, they exhibit moderate respiratory symptoms, like fever, dry cough and exhaustion. They were all free of COVID-19 pneumonia. Aim: To compare the clinical features and short-term outcomes of COVID-19 in children during March 2020 to March 2022. Materials and Methods: The present analytical observational study was conducted in the Department of Paediatrics, Chettinad Hospital, Chennai, Tamil Nadu, India, from March 2020 to March 2022. The study population included Reverse Transcription-Polymerase Chain Reaction (RT-PCR) positive COVID-19 children between age groups of one month and 18 years age. A sample size of 103, 90 and 98 were included from first, second and third wave, respectively. Kruskal-Wallis test and Analysis of Variance (ANOVA) test were used were used for statistical analysis. Results: In the study population, the mean age in the wave 1, wave 2 and wave 3 was 9.1±5.25 years, 9.3±4.99 years and 9.2±5.12 years, respectively. Males were more affected in all the phases than females. The most common symptoms in all the three waves were cough, myalgia and fever. Fever was the predominant symptom reported in all three waves (74.8% in wave 1, 80.6% in wave 2 and 75% in wave 3). Between the COVID-19 waves, baseline investigations such as Alanine Transaminase (ALT) and Aspartate Transaminase (AST) (p-value=0.001, 0.02) showed significant differences. C-reactive Protein (CRP) was non reactive in (81.55%) in wave 1, (85.07%) in wave 2 and (65.3%) in wave 3. (p-value=0.029). Conclusion: The present study results conclude that the presenting features of COVID-19 in children were mild, and the outcome was good. The first, second and third waves had considerable differences in clinical findings and short-term outcomes among COVID-19-affected children.

Comparison of Bupivacaine with Two Different Doses of Clonidine under Spinal Anaesthesia in Infraumbilical Surgeries- A Randomised Clinical Study

Introduction: Spinal anaesthesia is known as a safe and effective way to give anaesthesia during infraumbilical and lower limb surgeries. Intrathecal clonidine is a safe non opioid adjuvant used with local anaesthetics to prolong sensory and motor block, promotes sedation and analgesia. Aim: To compare the effects of bupivacaine with two different doses of clonidine under spinal anaesthesia in infraumbilical surgeries. Materials and Methods: This randomised double-blinded study was conducted in the Department of Anaesthesiology at Hind Institute Of Medical Science, Sitapur, Uttar Pradesh, India. The duration of the study was 19 months, from January 2021 to August 2022. A total of 60 patients (36 males and 24 females) were enrolled in the study and were randomly assigned to one of two groups (group A and group B) of 30 patients each. Group A bupivacaine heavy 12.5 mg with 15 mcg of clonidine, total volume 3 mL and group B bupivacaine heavy 12.5 mg with 30 mcg of clonidine, total volume 3 mL. The study parameters were: onset of sensory and motor block, duration of postoperative analgesia and any side effects (hypotension, bradycardia, sedation or any other). The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age of the study participants group A (44.51±12.84) years and group B (42.28±13.12) years. The demographical data showed comparable findings. The mean of onset of sensory (160.37±33.64) seconds and motor block (197.2±12.36) seconds in group B was statistically lower than group A. The mean duration of analgesia in group A (302.58±18.62) minutes was lower than group B (318.73±29.46) minutes. The mean Visual Analogue Scale (VAS) score was higher at every follow-up in group A as compared to in group B. The mean Ramsay sedation score was significantly higher in group B at every follow-up than in group A. Conclusion: Spinal anaesthesia was performed with 0.5% bupivacaine heavy with 30 mcg clonidine was proven to be a more effective adjuvant in providing early onset of the sensory and motor blockade intraoperatively and prolongation of the duration of effective postoperative analgesia when compare to 15 mcg clonidine.

Influence of Gender on Stress among School Children: A Cross-sectional Study

Dheerendra Kumar Mishra, Umesh Pratap Singh, Prashant Maravi, Akshat Varma

Introduction: The perception of stress by students affects their academic performance significantly. Continuous exposure to stress for a long time can cause both physical illnesses (including heart disease), and mental illnesses (e.g., anxiety disorders). Furthermore, stress increases the risk of suicide in students which is an important cause of adolescent mortality. Perception of stressors depends upon the biological, social, and psychological factors of students. Moreover, biological differences between male and female students attributed to the significant difference in experiencing stress among them. Aim: To study the gender difference and stress levels among adolescent school students. Materials and Methods: A cross-sectional study was conducted in Government boys higher secondary school and Government girls higher secondary school Mauganj, a town of Madhya Pradesh, India, between August 2016 to September 2016. The state board of examinations and the Hindi medium of instruction were followed in the school. A total of 40 study subjects, 24 males and 16 females were recruited for study after obtaining written informed consent from participants by simple random sampling method. The self-administered student stress scale was used to measure participants’ levels of stress and socio-demographic information, including age, sex, education, was recorded in semi-structured data entry proforma. The data were summarised using means with standard deviations and frequencies with percentages. Comparative analyses between the genders were conducted using the Student’s t-test (for continuous variables). The p-value ≤0.05 was considered level of significance. Results: A total of 40 study participants were included with mean age of 16.2±2.2 years. A total of 24 were male students and 16 were female students, amongst included subjects. Majority of student’s family practiced Hindu religion. Total stress score was 84.3±7.5 for male and 96.2±5.5 for female students (p=0.001). Conclusion: Significant amounts of stress were felt by students in high school. Male and female students perceived similar levels of stress in their academic and vocational domains, but female students felt significantly more stress in their financial, emotional, familial, and social domain. Student total stress levels were significantly higher for female students than male students.

Postoperative Analgesic Efficacy of Low Dose Intravenous Dexmedetomidine and Intraperitoneal Dexmedetomidine with Bupivacaine in Patients undergoing Laparoscopic Cholecystectomy: A Randomised Prospective Study

Lakshmi Sowjanya Chandra, Anusha Suntan, Santosh Alalamath, Vijay V Katti

Introduction: Providing a better analgesia in the postoperative period improves the overall outcome in any surgical procedure in terms of better patient satisfaction, early recovery and shorter hospital stay. Multimodal analgesia using α 2 agonists like clonidine and dexmedetomidine along with local anaesthetics via intraperitoneal route had been proved to provide better analgesia in laparoscopic cholecystectomy. Aim: To evaluate the postoperative analgesic efficacy of low dose 0.5 μg/kg dexmedetomidine via intravenous (i.v.) and intraperitoneal (IP) route in laparoscopic cholecystectomy. Materials and Methods: This was a randomised prospective study carried out in the Department of Anaesthesiology at BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital, and Research Centre, Vijayapura, Karnataka, India from December 2020 to September 2022. The study comprised of 99 patients of either gender, with American Society of Anaesthesiologists (ASA) Grade-I or II, were randomly allocated into three groups using computer generated randomised slips with 33 in each group (Group IV, Group IP, Group C). Group C (Control) patients received 30 mL of Normal Saline (NS) i.v. and 40 mL of 0.25% bupivacaine IP, Group IV patients received 0.5 μg/kg dexmedetomidine infusion i.v. in 30 mL NS over 10 minutes and 40 mL of 0.25% bupivacaine, IP. Group IP patients received 30 mL NS IV and 0.5 μg/kg dexmedetomidine in 40 mL of 0.25% bupivacaine IP. The time of rescue analgesia, total consumption of diclofenac in 24 hours, Visual Analogue Scale (VAS) pain score at 0.5, 1, 2, 4, 6, 12, 24 hours was compared among the three groups. Side-effects of the study drugs especially hypotension and bradycardia were monitored. All the data was analysed using statistical tests (Independent t-test, Kruskal-Wallis test, Chi-square test). The p-value was found to be statistically significant (p<0.005). Results: The VAS score was found to be consistently high in control group at all given time intervals, and significantly low in both i.v. and IP groups which were comparable. The Group IV had the longest mean time for rescue analgesia (180.91±41.617 minutes), followed by the Group IP (106.06±8.269 minutes), and the Group C (55.00±6.960 minutes). The consumption of total rescue analgesic (diclofenac) was determined to be highest in the Group C (241.82±30.767 mg) and lowest in the Group IP (115.30± 30.896 mg). Conclusion: The total consumption of diclofenac and VAS score was less in intraperitoneal dexmedetomidine was found to be effective in producing postoperative analgesia and can be considered as an effective alternative.

Impact of Oral Health on the Oral Health Related Quality of Life (OHRQoL) among Individuals with Intellectual Disabilities in Chennai, India: A Cross-sectional Study

Introduction: The risk of developing oral diseases is higher among individuals with disabilities compared to those who do not have any form of impairment or disability. Dental caries and periodontal diseases are the two most prevalent diseases among the individuals with disabilities worldwide and dental treatment is considered as the greatest unattended health need and oral diseases can have varying impacts on well-being and life quality of people. Aim: To assess the impact of oral health on the Oral Health Related Quality of Life (OHRQoL) of patients with intellectual disabilities in Chennai, India. Materials and Methods: The present cross-sectional school-based study which was conducted in the Department of Public Health Dentistry, Tagore Dental College and Hospital, Chennai,Tamil Nadu, India, from August 2021 to September 2021. Study was conducted among the parents of 12-25-year-old intellectually disabled individuals studying in special schools in Chennai, India. The estimated sample size was 122 with 95% of power and effect size of 0.3. OHRQoL of the participants with intellectual disabilities was assessed using the short-form versions of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and impact of Oral health on the family life of participants with intellectual disabilities using Family Impact Scale (FIS). Clinical examination of oral health status was assessed using self-designed proforma based on the World Health Organisation (WHO) basic oral health survey 2013. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 24.0. Results: The number of participants between 12-18 years was 111 (91%) and 19-25 years was 11 (9%) and 68 (55.7%) were males and 54 (44.3%) were females. The results showed that most of the parents 83 (68.03%) were concerned about their child’s bad breath with regard to P-CPQ and with regard to the FIS highest mean was recorded for child needs more attention from them (2.93±0.89) and sleep disturbances (2.80±0.49) among parents. Most (n=52, 42.6%) of them had decayed teeth compared to filled (n=14, 11.5%) and missing teeth (n=17, 13.9%). Majority (n=83, 68.1%) of the participant had fair oral hygiene. There was a positive correlation of oral symptoms and social well-being with the dentition status, Oral Hygiene Index-Simplified (OHI-S) and gingival index. Conclusion: A positive correlation was recorded between the oral symptoms of P-CPQ with the oral health status of the study population with stronger correlation recorded for oral hygiene. With regard to functional limitation there was a negative correlation with gingival index and for emotional well-being there was a negative correlation with dentition status and gingival index.

Comparison of General Anaesthesia and Epidural Anaesthesia in Lumbar Microdiscectomies- A Prospective Comparative Study

Dona Elsa Jose, Litha Mary Mathew, Ivan Koshy, Anita Mathew, P Ganapathi

Introduction: Lumbar Microdiscectomy (LMD) is most commonly performed under General Anaesthesia (GA). Regional techniques are being used more widely now, with Epidural Anaesthesia (EA) being safer than Spinal Anaesthesia (SA). Regional anaesthetic methods are being used increasingly, with EA being less harmful than spinal with respect to cardiac and neurological complications. Aim: To compare the intraoperative and postoperative outcomes of GA and EA in single level lumbar microdiscectomies. Materials and Methods: This prospective comparative study was conducted at a single tertiary care centre between April 2014 to April 2018 and study was conducted among 40 patients who were posted for single level lumbar microdiscectomies. The patients underwent surgery under group GA and group EA. Intraoperatively, parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Surgical Onset Time (SOT), Surgical Time (ST), Total Operating room Time (TOT) and postoperatively Visual Analog Scale (VAS) for pain, the Total Analgesic Dose (TAD) of fentanyl, Postoperative Nausea and Vomiting (PONV) and the level of satisfaction with regard to pain relief (4-point Likert scale) for the first 24 hours were compared. The data were analysed using Statistical Package for Social Sciences (SPSS) version 18 software. Mean, percentage, student’s t-test, χ2 test, Mann-whitney test and appropriate statistical tests were used. Results: A total of 40 patients were enrolled in the present study with rather similar demographic characteristics in both groups. The SOT was significantly more in the EA group (24.30±2.958 min) when compared to the GA group (14.05±2.259) minutes. However, the ST and TOT did not show much of a difference. Intraoperatively, group GA showed significantly high HR and MAP values when compared to group EA (p<0.001). Postoperatively, VAS for pain and the TAD of fentanyl were found to be significantly lesser in the EA group, when compared to GA group. The incidence of Postoperative Nausea and Vomiting (PONV) was less in EA group. The level of satisfaction with regard to pain relief at the end of first 24 hours was more among patients in EA group. Conclusion: The present study concludes that, EA may be used as an alternative to GA in single level lumbar microdiscectomies.

Evaluation of Outcomes between the Right and Left-Sided Transperitoneal Laparoscopic Adrenalectomy in a Tertiary Care Center: A Retrospective Study

Venkateshwara Rao Kakarla, Sanjay Parachuri, M Dileep, Kunal Mehra

Introduction: Several studies have corroborated the feasibility and safety of Transperitoneal Laparoscopic Adrenalectomy (TLA) for the removal of adrenal tumours however, there is very limited clinical evidence comparing right and left TLAs. This comparison enables surgeons in preoperative counseling of patients regarding postoperative outcomes. Aim: To evaluate the outcomes between the right and left-sided laparoscopic adrenalectomy in patients admitted to a tertiary care centre. Materials and Methods: The present retrospective study considered data from patients, who underwent TLA between December 2013-December 2019 admitted to the Vydehi Institute of Medical Sciences and Research Centre, based in Bengaluru, India. All the selected subjects with adrenal tumours were operated on by a single surgeon through a standardised transperitoneal laparoscopic approach for right and left-side adrenalectomies. The data collected were age, gender, symptoms, size of the tumour, duration of surgery, intraoperative blood loss, complications, duration of stay and histopathology of tumours. Both sides were compared for age, gender, size of tumour, operative time, blood loss, duration of hospital stay, histopathological diagnosis, benign and malignant lesions. The Student’s t-test was used for the evaluation of continuous data and the Chi-square test and Fisher’s-exact test for categorical variables. Results: The study considered the data of 42 patients. The corresponding number of subjects who had undergone right and left adrenalectomies for various adrenal pathologies were 18 (42.85%, 9 each of both genders) and 24 (17 males, 7 females). The mean age for right-sided adrenalectomy was 44.17 and the left-side was 46.83. The mean tumour size (in cm) was significantly larger in the right-side group as opposed to the left-side (7.97±2.77 vs 5.62±2.38, p-value <0.01). The duration of surgery (136.22±25.53 vs112.92±27.21 min, p-value <0.01) and average intraoperative blood loss were also more in the right-side group (431.67±259.73 vs 277.08±193.92 mL, p-value=0.02). There was no significant difference in the mean duration of hospital stay between the groups (3.94±1.06 vs 3.71±1.16, p=0.25). The most common tumour was adenoma in both groups. No major complications were noted in either group. Conclusion: Outcomes were comparable between right and left-side adrenalectomies. However, longer mean operative time and larger tumour size were noted for right-side laparoscopic adrenalectomy.

Alterations in Liver Enzymes in the Postoperative Period Following Laparoscopic and Open Cholecystectomy: A Prospective Study

Upasana Choudhury, Partha Sarathi Dutta

Introduction: Laparoscopic Cholecystectomy (LC) is one of the most common procedures that is being performed by a general surgeon, and is the treatment of choice for symptomatic gallstone disease. Any abnormalities in the postoperative period because of the procedure is a thing of concern for the operating surgeon. Aim: To compare the changes in the levels of liver enzymes in the immediate and delayed postoperative period following LC and following Open Cholecystectomy (OC) with respect to the preoperative values. Materials and Methods: This was prospective interventional study carried out in the General Surgery wards of Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India, from February 2020 to August 2021. A total of 43 patients who underwent LC and 43 patients who underwent OC were randomly selected from the surgical wards. Their levels of Alkaline Phosphatase (ALP), Aspartate Transaminase (AST), Alanine Transaminase (ALT) and total bilirubin were noted in the preoperative period, 24 hours after the surgery and seven days after the surgery. The changes in the levels of the above-mentioned parameters were analysed using paired t-test via International Business Machines Statistical Package for the Social Sciences II (IBM SPSS II) software version 25.0. Results: The mean age of the study participants who underwent OC was 40.98±12.46 years while the mean age for those who underwent LC was 36.42±10.53 years. There was a significant increase in the levels of AST (27.02±7.272 IU/L to 53.70±19.902 IU/L), ALT (26.21±7.399 IU/L to 50.21±14.410 IU/L) and total bilirubin (0.601±0.173 mg/dL to 0.782±0.261 mg/dL) in the immediate postoperative period (24 hours after surgery) p-value <0.01 among the patients who underwent LC but returned to its baseline preoperative value within seven days of the surgery. No such significant change was noted in the levels of the liver enzymes (AST: 30.93±8.160 IU/L to 32.14±16.988 IU/L, ALT: 31.51±10.762 IU/L to 31.14±10.921 IU/L) among patients undergoing OC. Conclusion: The transient increase in the liver enzymes (AST, ALT and total bilirubin) 24 hours after LC maybe related to the increased intra-abdominal pressure due to CO2 pneumoperitoneum which decreases the venous return and thereby cardiac output, thus leading to tissue ischaemia. Absence of this effect leads to no significant change in the liver enzymes in the postoperative period following OC.

Morphometric Analysis of Age and Gender-related Variations of Corpus Callosum by using Magnetic Resonance Imaging: A Cross-sectional Study

Navbir Pasricha, Eti Sthapak, Ashish Thapar, Rajan Bhatnagar

Introduction: The Corpus Callosum (CC) is the largest commissural bundle connecting the two cerebral hemispheres which is involved in learning, memory, thinking, three-dimensional visual ability, executive functions as well as behavioural patterns. Exact morphometric dimensions are a prerequisite before surgical interventions and stereotactic approaches to the foramen of Munro and also in cases of callosectomy for intractable epilepsy as inconsistencies exist regarding gender and age related changes of CC. Also, most published studies are from the western world and very few studies are from South-east Asia and India. Aim: To study the morphometry of CC and possible age, gender related variations using Magnetic Resonance Imaging (MRI) in the North Indian population. Materials and Methods: An observational, cross-sectional study was done in Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India from January 2019 to October 2019. A total of 200 head MRI scans, using PACS (Picture Archiving and Communication System) System Viewer software were evaluated. In all the scans, length, height, minimum and maximum thickness of CC were studied. The data were statistically analysed using STATA Software for age and gender-related differences. Student’s t-test, one-way Analysis of Variance (ANOVA), linear regression and Pearson correlation coefficient were applied. Results: The study showed decrease in thickness of body, rostrum and splenium with age, linked to generalised degeneration of cortical neurons or atrophy of white matter with advancing age. Also, there was increase in length with age, possibly due to age mediated structural dilatation in lateral ventricles. Statistically significant sexual dimorphism was observed as a larger CC length in males (74.24±4.26 mm) than females (72.67±4.16 mm) (p-value <0.001) and larger brain length in males (171.75±5.51 mm) as compared to females (163.70±5.75 mm) (p-value <0.001). Males also showed greater splenial thickness (10.15±1.79 mm) in comparison to females (9.68±1.51 mm) (p-value <0.001) which may represent the importance of distribution of fibres of visual cortex in males due to larger occipital lobe. Conclusion: The present study documented morphometry of normal CC in different gender and age groups and observed sexual dimorphism, especially greater CC length and splenial thickness in males than females. With age increase in the length and decrease in thickness of CC was seen.

Progression of Diabetic Retinopathy during COVID-19 Pandemic: A Retrospective Study

Introduction: Emergence and subsequent exponential spread of Coronavirus Disease-2019 (COVID-19) infection during 2020 forced the Government to issue countrywide lockdown from March 2020. Diabetic Retinopathy (DR) is one of the debilitating diseases of the eye which requires regular follow-ups and timely intervention to prevent permanent vision loss. The impact of countrywide lockdown on prevalence and progression of DR needs to be evaluated. Aim: To assess the effect of COVID-19 pandemic situation on the prevalence and progression of DR and analyse the possible risk factors for progression of DR in the ongoing pandemic period by comparing retrospective data from immediate prepandemic quarter with post lockdown quarter. Materials and Methods: This retrospective study was conducted in the Department of Opthalmology at Regional Institute of Ophthalmology, Kolkata, West Bengal, India. The study was done during the prepandemic period, from November 2019 to February 2020. In the present study, a cohort of 83 diabetic patients with pre-existing DR was selected from past medical records and compared with post lockdown period during November 2020 to February 2021. Data regarding prevalence of various types of DR, mean Central Macular Thickness (CMT), mean Visual Acuity (VA), proportion of patients requiring >3 doses of monthly anti-Vascular Endothelial Growth Factors (VEGF) and additional laser therapy or vitrectomy, VA improvement and reduction of mean CMT were gathered and compared between those two quarters. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The prevalence of moderate Non Proliferative Diabetic Retinopathy (NPDR) (13% vs 25%), severe NPDR (19% vs 8%), Proliferative DR (PDR) (18% vs 7%), Advanced Diabetic Eye Disease (ADED) (4.8% vs 1%) and Diabetic Macular Oedema (DME) (62% vs 28%) increased several folds during post lockdown quarter in comparison to prepandemic quarter. There was a statistically significant difference (p-value <0.05) in baseline mean LogMar Best Corrected Visual Acuity (BCVA) (0.4±0.08 vs 0.9±0.07), mean CMT (386.4±26.8 to 421.8±21.6) positive correlations of some of the possible risk factors for poor visual outcome among the same cohort of patients in the post lockdown period: poor socioeconomic status (35%; Odds Ratio (OR): 3.59, Relative Risk (RR): 2.68), irregular diabetic medication (52%; OR: 3.56, RR: 2.23), residence more than 100 km from the hospital (38%; OR: 3.03, RR: 2.26). Conclusion: The present study, concludes that, the status of DR stage among study subjects in the post lockdown period has deteriorated when compared with the prepandemic period.

Antimicrobial Prophylaxis in Lower Uterine Segment Caesarean Section: A Prospective Observational Data-based Study

Introduction: Any major surgery like lower uterine Caesarean Section (CS) can be hazardous due to postoperative nosocomial infection. Pregnant mothers are at greater risk during such surgical intervention as compared to vaginal delivery. Prophylactic antibiotic administration is a standard practice across the globe to prevent such anticipated postoperative infection. Aim: To evaluate the prophylactic antimicrobial use with regards to the choice of antimicrobials, dose, route, timing and duration, any possible Adverse Drug Reaction (ADR) as well as to assess the frequency of the postoperative morbidity due to infection (if any). Materials and Methods: A prospective observational data-based study was conducted in the Department of Pharmacology in collaboration with Department of Obstetrics and Gynaecology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India, from February 2016 to October 2017. Study was conducted on 1944 pregnant women of reproductive age group planned or scheduled for elective/emergency lower segment CS, but otherwise healthy and received prophylactic antimicrobials for the surgery. They were prospectively observed regarding the treatment they received with focus on antimicrobial agents from the period of antimicrobial prophylaxis during their stay at hospital till their discharge. Demographic data, vital signs, indication of CS, postoperative infections and ADR if any were recorded in predesigned proforma. The study population was divided into two groups: group A included 995 mothers, who received ceftriaxone sodium (1 g intravenously) and metronidazole (15 mg/kg) infusion and group B included 949 mothers, who received ampicillin (2 g intravenously), metronidazole (15 mg/kg) infusion and injection gentamycin (5 mg/kg) for 0.5 hour before initiation of CS. The data were statistically analysed by standard statistical software Microsoft excel 2010 and Statistical Package for the Social Sciences (SPSS) sotware version 27.0 (SPSS Inc., Chicago, IL, USA) expressed as mean and standard deviation and percentage. Independent t-test and Chi-square test were used for analysis. Results: The mean age of group A was 22.36±3.07 years and group B was 22.76±2.47 years. Endomyometritis was documented in 4 (0.4%) from group A and 2 (0.21%) from the group B. Wound infection was present in 3 (0.3%) for group A and five (0.5%) for the group B. Infection related complications like chest infection seen in 7 (0.7%) for group A and in 3 (0.31%) for group B and urinary tract infection was noticed in 6 (0.6%) for group A and 5 (0.52%) for group B. Any incidence of maternal mortality was not evident among the two study groups and statistically insignificant ADR like vomiting and maculopapular rash (p-value=0.324) was observed in both the study groups with the use of abovementioned antimicrobial therapy. Conclusion: Prophylactic use of ceftriaxone plus metronidazole and combination of triple antimicrobial therapy of ampicillin, metronidazole, and gentamycin therapy at the usual standard dose were commonly used antimicrobials at the present set up and they are safe and equally effective in decreasing considerably the incidence of post caesarean maternal infection thereby reducing their morbidity and mortality.

Effect of Herbal Perfumes and Synthetic Perfumes on Attention and Cognitive Functions in Young Adults: A Sequential Cross-sectional Study

Introduction: Focused and sustained attention, executive function, working memory and task switching are important cognitive abilities. Efforts to enhance cognitive abilities, have engaged the scientific community since ages. Human beings are exposed to several fragrances and the perception of the sense of smell, plays an important role in the physiological effects of mood, stress, and working capacity. Perception of olfactory stimuli involves complex brain processing, which can be directly associated with cognition and emotion. Several Electroencephalogram (EEG) studies have revealed that, fragrances significantly modulate the activities of different brain waves and are responsible for various states of the brain. Aim: To objectively demonstrate the effect of olfactory stimulation with herbal (rose) perfume on attention and executive functions. Materials and Methods: This sequential cross-sectional study was conducted in the Department of Physiology at Osmania Medical College, Hyderabad, Telangana, India. The duration of the study was one month, from 16th August 2021 to 16th September 2021. Study included 40 healthy participants (15 males and 25 females), aged between 18-30 years to olfactory stimulation by herbal (rose) extract perfume and synthetic (rose) perfume, and the effects are assessed, using the psychophysiological tests viz., Rapid Serial Visual Presentation task (RSVP), Trail Making Tests (TMT) A and B, Ruff Figural Fluency Test (RFT), and compared with the baseline scores, which are then analysed using Paired t-test. The data was analysed by using Statistical Package for Social Sciences (SPSS) version 16.0. Results: Olfactory stimulation with herbal rose perfume enhances the attention and speed of processing, as shown by the nearly significant improvement in the performance of the TMT-A (p-value=0.05433), with decreased time taken to perform the test, whereas, the synthetic rose perfume enhanced the attention, speed, switching between tasks, cognitive fluency, and flexibility. This is evident by the significant improvement in the performance of the TMT-A (p-value=0.00326) and TMT-B (p-value=0.0001693), with decreased time taken to perform the tests. The derived index TMT (B-A), which removes the speed component and is a purer index of executive functions, also showed significant results (p-value=0.002092). Conclusion: The effects of herbal and synthetic rose olfactory stimulation have shown positive influence on the attention and cognitive functions and this finding can be applied to create student friendly learning environments, by providing pleasant stimuli through means of aromatic sprays delivering the odorant in a pulsatile manner at a frequency to overcome the ensuing olfactory adaptation.

Treatment of Dentinal Hypersensitivity with Diode Laser of Two Different Wavelengths- A Randomised Clinical Trial

Introduction: Dentinal Hypersensitivity (DH) is one of the most prevalent dental issues that is treated by both periodontists and endodontists. Hypersensitive dentin is a sensitive or painful response that is one of the most prevalent and poorly treated chronic dental disorders. Due to the difficulty in treating cervical DH, a great range of approaches and therapeutic procedures for pain relief in have developed. Treatments with desensitising drugs have been combined with laser treatment in recent decades. The most often utilised lasers in the treatment of DH are Diode Lasers (DL). DL act on DH provoking a melting effect with crystallisation of dentine inorganic component and the coagulation of fluids contained into the dentinal tubules. Aim: To compare the effectiveness of DL of two different wavelengths in managing DH. Materials and Methods: This split-mouth randomised clinical trial conducted in the Department of Periodontology at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. The duration of the study was, from October 2021 to December 2021. A total of 12 patients with DH were selected and assigned to two groups. All the patients were subjected to desensitisation using DL of two different wavelengths 475 nm Bluelase system and 810 nm. Denlase system and parameters were evaluated 15 minutes after treatment, 7 days, 15 days and 30 days after treatment. Data were entered in Microsoft excel and analysed using Statitical Package for Social Sciences (SPSS) version 10.5 software. Results: The mean age of the study participants was 45±3 years. There was a significant difference (p-value <0.001) in tooth sensitivity values measured at baseline, and at different time intervals in both groups. Among the two groups, Denlase group showed the greatest reduction in Visual Analogue Scale (VAS) scores from baseline to one month recall compared to Bluelase laser group. Highly significant difference was found when mean VAS scores were compared between baseline and all the other time points (p-value <0.001). Conclusion: The present study concluded that, based on the results obtained, DL of 810 nm Denlase system was effective than DL of 475 nm Bluelase system in reducing the DH. Desensitisation treatment with laser irradiation has shown to be effective in the present study.

Antimicrobial and Mechanical Properties of GIC Incorporated with Silver Vanadate Nanoparticles: An In-vitro Study

Introduction: Glass Ionomer Cement (GIC) is a widely used restorative material, but its antibacterial property is not sustained overtime. The addition of nanosized silver vanadate (AgVO3) is an attempt to enhance the antibacterial property of GIC without affecting its mechanical properties. Aim: To evaluate the antimicrobial property, Flexural Strength (FS) and Surface Micro Hardness (SMH) of GIC added with silver vanadate (AgVO3) nanoparticles. Materials and Methods: This in-vitro study was conducted in the Department of Pedodontics, Vishnu Dental College, Bhimavaram, India from June 2020 to July 2021. The AgVO3 nanoparticles were proportionally added to Type II GIC (Group 1) powder at the concentrations of 0.5% (Group 2), 1.0% (Group 3) and 2.0% w/w (Group 4). A total of 56 specimens were prepared to evaluate the test parameters. Antimicrobial property was evaluated using disk diffusion method. FS was determined using a universal testing machine and SMH using Vicker’s Microhardness (VHN) tester. The obtained data was analysed using one-way analysis of variance (ANOVA), Tukey’s test and unpaired t-test. Results: The GIC with AgVO3 nanoparticles exhibited higher antimicrobial property compared to unmodified GIC (Group 1). Group 4 exhibited highest antimicrobial property, followed by Group 3 and Group 2. Group 4 exhibited highest FS with a mean value of 26.90 MPa (p=0.002) and SMH with a mean value of 61.29 VHN (p=0.001) than Group 1. Conclusion: Addition of 2.0% w/w AgVo3 nanoparticles to Type II GIC shown to have higher antibacterial property, and also displayed higher FS and SMH.

Impact of Fluoride on the Corrosion Pattern of Pure Titanium and Titanium Alloy Combined with Nickel-Chromium Alloy and Gold Alloy: An In-vitro Study

S Ramesh Raja, M Aarti Rajambigai, TC Giri, V Amalorpavam, Tamilselvan Kumar

Introduction: Currently, Fluoride ions are added to commercially available tooth paste, mouth washes and cariostatic gels for their prophylactic action. However, the preventive effect may also be accompanied by the corrosive activity, through infiltration of fluoride-containing saliva in the contact between crowns and bridges or into the implant supported structure. Aim: To evaluate the corrosion action of Sodium Fluoride (NaF) on Pure Titanium (PT) and its alloy coupled with Nickel-Chromium (Ni-Cr) alloy (NC) and Gold (Au) Alloy (GA). Materials and Methods: This in-vitro study was conducted in the Department of Prosthodontics at Central Electrochemical Research Institute, Karaikudi, Tamil Nadu, India. The duration of the study was six months, from April 2010 to September 2010. A total of 48 specimens were categorised under four groups. The four groups included for the study were pure group I (PT+GA), group II (PT+NC alloy), group III {Titanium Alloy (TA)+GA) and group IV (TA+NC alloy}. The specimens under each group were divided into half and were immersed in 100 mL of either artificial saliva or artificial saliva with 1000 Parts Per Million (ppm) fluoride. The current was passed at a scanning rate of 1800 mV/hour for 60 minutes and changes in corrosion potential were observed. The elemental release analysis test was conducted by using inductively coupled plasma-mass spectrometry to quantitatively analyse the elements (metal ions) released in the test solution from the galvanic coupling alloys. In order to evaluate the corrosion behaviour, the surfaces of the specimens were examined with an optical microscope (Eclipse LV100D, Nikon, USA). Analysis of Variance (ANOVA) was done for intergroup comparison. Statistical significance was set at 5%. Results: The mean value of corrosion of PT+GA and PT+NC was 13 μg/cm2 and 27 μg/cm2 respectively. The mean value of corrosion of TA+GA and TA+NC was 12 μg/cm2 and 24 μg/cm2 respectively, in artificial saliva without sodium fluoride. In the presence of sodium fluoride, the mean value of corrosion of PT+GA and PT+NC was 17 μg/cm2 and 60 μg/cm2 respectively, and the mean value of corrosion of TA+GA and TA+NC was 15 μg/cm2 and 41 μg/cm2. The PT and TA specimens coupled with NC alloy specimens showed more corrosion in saliva either with or without sodium fluoride compared to GA. Conclusion: The NC alloy specimens coupled with PT and TA specimens showed severe pitting corrosion in artificial saliva containing sodium fluoride.

Isocitrate Dehydrogenase (IDH1) and p53 Mutations in Gliomas: A Cross-sectional Study from a Tertiary Care Hospital, Karnataka, India

Nissy J Louis, Sapna Patel, Harish Srikantegowda

Introduction: Gliomas, being the most common Central Nervous System (CNS) neoplasms, are broadly divided into astrocytomas, oligodendrogliomas and ependymomas. World Health Organisation (WHO) 2016 criteria incorporated Immunohistochemistry (IHC), molecular diagnostic techniques and histological tumour grading into its diagnostic criteria. Isocitrate Dehydrogenase (IDH1) mutations are commonly seen in young people with good prognostic implications. The detection of Tumour Protein53 (p53) mutations in gliomas and its association with the grade of the tumour can be used as a diagnostic, prognostic and therapeutic tool for better survival in affected individuals. IHC can be used as surrogate markers in detecting the mutational status of IDH1 and p53. Aim: To study the expression of IDH1 and p53 mutations in gliomas and to evaluate its association with known clinicopathological variables. Materials and Methods: This cross-sectional, retrospective, analytical study was conducted in the Department of Pathology at JSSAHER, Mysuru, Karnataka, India, from October 2018 to September 2022. All histopathologically diagnosed glioma cases, who underwent surgery, were appropriately reviewed and graded. IHC was performed for the detection of IDH1 mutational status and p53 expression. The tumour was labelled as, IDH1 positive with cytoplasmic staining and p53 positive when nuclear staining was observed in more than 5% of tumour cells. The p53 expression was further quantified in scores as low ≤8 and high >8 score. The associations of clinicopathological variables and the comparison of the scores of p53 mutation across various categories of gliomas were analysed statistically. The data was analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Results: The mean age of the study participants was 42.6 years with the standard deviation of 12.8 years. A total of 35 cases (20 males and 15 females) were analysed. The maximum number of cases was in the age group of 31-40 years (n=13) followed by 41-50 years of age group (n=11). Three of them were seen in age less than 20 years. The male: female ratio was 1.33:1. Out of total cases, 20 cases showed IDH1 positivity, 11 cases showed high p53 expression and five cases demonstrated both IDH1 positivity and high expression of p53. A statistically significant association (p-value=0.014) was seen between the grade of the tumour and p53 immunoreaction. Conclusion: The present study of the detection of IDH1 and p53 mutations, could provide reliable information for improved tailoring of patient therapy as study revealed that, there was a significant association of p53 expression with the grade of the tumour with low expression in low grade gliomas and high p53 expression in high grade gliomas.

Proportion of Co-morbidities in Patients with and without Bullous Pemphigoid: A Cross-sectional Study

Sathyavath Sumitra, Reena Chandran, Anuja Elizabeth George

Introduction: Bullous Pemphigoid (BP) is the most common subepidermal immunobullous disorder. It has been found to be associated with various co-morbidities. Only a few studies have been done previously, to find out the association between BP and these co-morbidities. A better understanding of the various co-morbidities in BP patients, enables to implement better treatment strategies, which will be more efficacious and less toxic. Aim: To compare the proportion of co-morbidities in patients with and without BP and to study the triggering factors associated with BP. Materials and Methods: This was a hospital based cross-sectional study conducted in the Department of Dermatology and Venereology at Government Medical College and Hospital, Trivandrum, Kerala, India. The duration of the study was one year and six months, from January 2020 to June 2021. A total of 80 patients were included in the present study, out of which 40 patients with BP were included in case group and 40 patients without BP in control group. Clinical data such as age, gender, habits, co-morbidities and factors triggering BP were recorded. Categorical and quantitative variables were expressed as frequency (percentage) and mean±SD respectively. Chi-square test and Fisher’s-exact test were used to find association between categorical variables and (p-value <0.05) was considered as statistically significant. Results: The mean age of the study participants was 60.8±10.5 years. A total of 23 (57.5%) patients and 20 (50%) normal subjects had a history of co-morbid illness. Diabetes, hypertension, neurological disorders, Coronary Artery Disease (CAD) and Chronic Kidney Disease (CKD) were the co-morbidities reported by the patients. Diabetes was the most commonly observed co-morbidity among the patients. A statistically significant difference was noted between the case and control group in terms of diabetes (p-value=0.039) and neurological disorders (p-value=0.011). A total of 34 (85%) patients had atleast one factor which triggered the onset of the disease, and the most common triggering factor was drug intake in 22 (55%) patients. Conclusion: The most commonly observed co-morbidity among patients with BP in the present study was diabetes. A prompt surveillance and adequate control of glycaemic status is needed in these patients in order to avoid further worsening of diabetes with corticosteroid therapy. Avoidance of various exogenous triggers such as disease worsening drugs, stress, excessive sun exposure etc., will help in achieving better control of the disease.

Efficacy of Probiotics in Preterm Neonates in the Prevention of Necrotising Enterocolitis: A Randomised Controlled Trial

B Sunil, S Bhavya

Introduction: The most frequent and dangerous gastrointestinal emergency in newborns is Necrotising Enterocolitis (NEC). A novel and promising strategy for preventing NEC is enterally given probiotics. Aim: To evaluate the efficacy of probiotics in preterm neonates in the prevention of NEC and to assess the time of achievement of full feeds and duration of Intensive Care Unit (ICU) stay. Materials and Methods: The present study was a parallel design single-centre randomised controlled trial, conducted in Neonatal Intensive Care Unit (NICU), Department of Paediatrics, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India, from November 2018 to April 2020. Total of 130 newborns were included after inclusion and exclusion criteria and were randomised into two groups: that is probiotic (group I, n=61) and non probiotic (group II, n=69) groups. The probiotic group was given probiotics with breastmilk and non probiotic group were given only breastmilk. Probiotic (Bifidobacterium breve M16V) 0.5 g was mixed with breastmilk and given twice daily till full feeds were reached. All neonates were followed-up on daily basis for the appearance of features of NEC. Other parameters like time of achievement of full feeds and duration of ICU stay were compared between the two groups. Descriptive and inferential statistical analysis was carried out in the present study. Results: Out of total sample, majority of babies belonged to the gestational age group of 30-33 weeks i.e., 30 (49.2%) in group I and 30 (43.5%) in group II. There were 29 (47.5%) females and 32 (52.5%) males in group I and, 32 (46.4%) females and 37 (53.6%) males in group II. There was a significant reduction of incidence of NEC (p-value=0.024) and earlier achievement of full feeds in the probiotic group (p-value=0.003) when compared to non probiotic group. The mean duration of ICU stay compared between the two groups was not statistically significant (p-value=0.366). Conclusion: Supplementation of probiotics to the preterm Low Birth Weight (LBW) babies helps in the reduction of incidence of NEC and also helps in earlier achievement of full feeds.

Pathogenic Organisms Causing Respiratory Infections in Patients with Chronic Kidney Disease, Stage V on Maintenance Haemodialysis: A Cross-Sectional Study

Raghu VS Rama Tanuku, Eeshita Badiya, Krishna Sree Major T Venkata

Introduction: Pulmonary infections are the most common infectious cause of disability and mortality in Chronic Kidney Disease (CKD) stage V patients on haemodialysis after cardiovascular disease. The incidence of pathogenic invasion of the lungs causing pneumonia is markedly higher in CKD stage V patients undergoing haemodialysis as compared to the general population. The risk is due to various factors including immune dysfunction, prolonged hospital stays leading to contact exposure, and hospital-acquired infections. The other important factors are anaemia, uremic toxins promoting pulmonary oedema, age, and vascular access through the arteriovenous fistula and internal jugular vein leading to catheter-induced respiratory infections. Aim: To study the common pathogens involved in causing lung infection in CKD stage V patients on maintenance haemodialysis. Materials and Methods: This cross-sectional study was conducted in the Department of Medicine/Nephrology at Andhra Medical College and King George Hospital, Visakhapatnam, Andhra Pradesh, India. The duration of the study was two months, from June 2019 to July 2019. A total of 50 patients were included in the study with CKD stage V on haemodialysis. The samples were between ages 18 to 75 years with respiratory symptoms and signs including fever, productive cough, and shortness of breath being the major complaints. These patients were subjected to certain investigations to isolate the organism. The parameters assessed were blood culture and sputum culture, haemoglobin, and chest X-ray. Sputum examination for Acid-fast Bacilli (AFB) was done to rule out tuberculosis. Statistical Package for Social Sciences (SPSS) version 17.0 was used for statistical analysis and measurement, data were expressed as the Mean±Standard Deviation (SD). Results: The majority of the subjects were in the mean age group of 49 years and males were predominantly affected. The commonly isolated organism was gram-negative bacilli-Pseudomonas, with access common through arteriovenous fistula as compared to Escherichia coli (E.coli), which was common in patients with access through Internal Jugular Vein (IJV). Conclusion: The respiratory infection, that posed the burden in the present study was pneumonia. The common organism isolated was gram-negative bacteria being pseudomonas. The respiratory infections identified, were more through Arteriovenous Fistula (AVF) access and common in patients with moderate to severe anaemia.

Heart Rate Variability and Cold Pressor Test before Onset of Pre-eclampsia in Pregnant Women-A Longitudinal Study

Tazyeen Fatima, Shobitha Muthukrishnan, Neha Gupta, Ashish Kumar Maurya

Introduction: A major obstetric complication, that leads to severe maternal and foetal morbidity is Preeclampsia (PE). Studies evaluating the autonomic nervous activity in pregnant women with PE shows conflicting results. Previous studies are inadequate for the identification of the most useful tools to detect and monitor autonomic dysfunction prior to PE. The cold pressor test is a simple and validated test, in which the afferent sensory pathways are stimulated by the cold stimulus, resulting in an increase in Blood Pressure (BP). Aim: To evaluate the response to cold pressor test and Heart Rate Variability (HRV) to detect increased vascular reactivity and sympathetic activity prior to the clinical manifestation of PE in pregnant women. Materials and Methods: A longitudinal study was conducted in in the Department of Physiology at Hamdard Institute of Medical Sciences, HAHC Hospital, Jamia Hamdard, New Delhi, India. The duration of the study was 11 months, from December 2018 to November 2019. Subjects were 50 pregnant women, between age 18-40 years and of 12-14 weeks of gestation. Cold pressor test and HRV were parameters measured for the assessment of the autonomic functions during 12 and 21 weeks of gestational period. The Statistical Package for Social Sciences (SPSS) version 26.0 was used for analysis of the quantitative data. Paired t-test was done for comparison of all values. Results: The mean age of the study participants was 29±2.7 years. There was no hyper-reaction to cold pressor test at 12 weeks of gestation, nor the subjects showed any signs of PE. At 14 weeks of gestation, 2 (4%) showed hyper-reaction to cold pressor test. At 21 weeks of gestation, 3 (6%) subjects showed hyper-reactions to cold pressor test and out of them, two developed PE. Root Mean Square Standard Deviation (RMSSD) and difference between adjacent Standard Deviation of N-N intervals (SDNN) of HRV analysis were significantly higher in the first trimester as compared to 21 weeks of pregnancy. Conclusion: Response to cold pressor test showed increased vascular reactivity, as a sign before the development of PE. HRV analysis could not detect any significant features of increased sympathetic activity prior to the clinical manifestation of PE in pregnant women.

Scope of Teledentistry during the Trying Times of COVID-19 Pandemic: A Patient Perspective Questionnaire Survey

Introduction: Teledentistry has provided a glimmer of hope for patients who require treatment, but are limited to their homes owing to Coronavirus Disease-2019 (COVID-19) restrictions. Like any other professional careers, dentistry also had to switch to a new normal mode of consultation and teledentistry came to its aid. With the support of advanced technologies dental care was made possible even though face to face interactions were to be refrained due to the curfew restrictions. Aim: To assess the scope of teledentistry from a patient’s perspective. Materials and Methods: The survey was designed as a descriptive cross-sectional study conducted in the Department of Periodontics, Karpaga Vinayaga Institute of Dental Sciences, Chengelpet, Tamil Nadu, on dental patients of Chennai, India, from April 2021 to May 2021 who made use of Telemedicine for dental consultation. The study population included those who sought teledentistry and the study included 100 participants. A computer aided self-administered questionnaire was designed and validated. Practicing dentists were requested to circulate a questionnaire containing 10 questions that assessed scope of teledentistry from patient’s perspective, to their patients at the end of their teleconsultation after obtaining consent. A total of 94 responses were obtained successfully out of 100 participants. Descriptive analysis of the obtained data was done using International Business Machines Statistical Package for the Social Sciences (IBM SPSS) software version 22.0. Results: The mean±Standard Deviation (SD) age of the study participants was 33±2.5 years, there were 51 males and 43 females. A 57.5% (n=54) of individuals made the best use of teledentistry during the lockdown and 59.6% (n=56) of the respondents felt that teledentistry was safe as it prevented the risk of unnecessary exposure and cross-infection. Of all, 79 (84.04%) respondents answered that they support teledentistry in the future. Suggestions were received requesting reduction in consultation fee and to increase consultation timings. Conclusion: Teledentistry proved to be an excellent alternate mode of dental service during the COVID-19 pandemic crisis. Moreover, it helped to bring down the cross-infection and made health services available to people caught up in inaccessible areas thus, making teledentistry a valuable tool that can be used on a day to day basis.

Analysis of Causes of Stillbirth in a Tertiary Care Hospital using ReCoDe Classification System: A Prospective Observational Study

Anju Gupta, Parneet Kaur, Sangeeta Rani Aggarwal

Introduction: Stillbirths account for a major proportion of perinatal deaths. In many cases of stillbirth, the cause remains unexplained. The ReCoDe system (classification of stillbirths by Relevant Condition at Death) is a frequently used classification system that has helped us to improve the understanding of the causes of stillbirths. Aim: To identify factors associated with stillbirths and to classify the causes of stillbirths using the ReCoDe system. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India, from February 2020 to January 2021. All the mothers with a history of antepartum and intrapartum foetal mortality with the diagnosis of intrauterine foetal death after 20 weeks of gestation were included in the study. A detailed history of the mother was taken and an examination of the mother, stillborn babies, placenta, and umbilical cord was done. ReCoDe system was used to classify the causes of stillbirth. For statistical analysis mean and percentages were used. Results: There were 287 women with intrauterine foetal death admitted during the study period. Maternal age ranged from 18-40 years, majority (n=157, 54.7%) women belonged to the age group of 24-29 years. The stillbirth rate was 78.95 per 1000 live births. The cause of stillbirth could be explained in 235 (81.89%) cases by using the ReCoDe system. Hypertensive disorders in 91 (31.71%) were the most common cause followed by foetal growth restriction in 46 (16.02%). Conclusion: According to the present study ReCoDe system was useful in classifying the causes of stillbirths in the resource-limited settings.

Management of Mycotic Otitis Externa: A Clinicomycological Study

Aniket R Buche, Sachin H Garud, AL Athul Krishna

Introduction: Fungi are eukaryotic heterotropic organisms. In otolaryngology, mycotic otitis externa is one of the most common infection affecting external ear canal. The predisposing causes for otomycosis are mostly preventable or adequately controlled by medical treatment. It is important to evaluate the predisposing factors elaborately and economical mode of treating the disease adequately. Aim: To evaluate the predisposing factors, clinical features and management of mycotic otitis externa. Materials and Methods: The present longitudinal study was conducted in the Department of Otorhinolaryngology, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India, from December 2019 to December 2021. A sample size of 150 patients was taken for study. The predisposing factors, clinical features with which the patients presented were studied clinically. Otoscopic examination was done and type of fungal colony identified. The ear swab from affected ear or ears are taken and sent for fungal culture. Thorough aural toileting done and maximum debri was removed. The fungal reports were collected and the patients response to treatment was evaluated at the end of four weeks. All the data collected was entered into a master chart in Microsoft excel 2019 and Statistical Package for the Social Sciences (SPSS) software version 23.0 was used for analysis of study. The p-value obtained is less than 0.05 and the study was hence proved significant. Results: Most (59.9%) of the patient’s age were from 16-45 years age group and there were 82 (54.67%) males and 68 (45.33%) females. The most common predisposing factor was unsterile methods of ear cleaning (86.6%) followed by administration of unsterile ear drops (72%). Aspergillus niger was the most common fungal isolate (62%) and clinically most (96.6%) of the cases responded to clotrimazole. Conclusion: Mycotic otitis externa being the most common fungal infection of external ear canal, can be treated adequately and effectively. The region-wise fungal population diversity identification will help in effective treatment. Aural toileting along with topical antifungal agents is found to be effective in majority of the cases.

Treatment Reconciliation in Parkinson's Disease Patients with Particular Reference to Wearing-off and Motor fluctuations: A Registry-based, Prospective, Observational Study

Introduction: Parkinson’s Disease (PD) is the second most frequent neurodegenerative disease and dopaminergic agents are frequently used as a treatment while ‘end of dose deterioration’ or ‘Wearing-Off (WO)’ phenomenon is common with these agents. Treatment reconciliation may be helpful in this situation and there is dearth of studies especially in India. Aim: To study the WO effects in patients of PD, their pharmacotherapy and outcome. Materials and Methods: This registry-based, prospective, observational, outcomes-based study was conducted in the Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, India, in collaboration with Department of Neuromedicine of Kolkata Medical College and private clinics of a Neurologist from January 2020 to December 2021. An attempt was also undertaken to make a registry of Idiopathic Parkinson’s Disease (IPD) patients. WO Questionnaire 19-items (WOQ-19), Movement Disorder Society- Unified Parkinson’s Disease Rating Scale (MDS-UPDRS Scale), The 39-items Parkinson’s Disease Questionnaire (PDQ-39 questionnaire), The 8-items Morisky Medication Adherence Scale (MMAS scale), suspected Adverse Drug Reaction (ADR) Reporting Form of Indian Pharmacoepia commission (version 1.3), World Health Organisation- Uppsala Monitoring Centre (WHO-UMC) Scale, Naranjo causality assessment scale, Hartwig and Seigel’s Severity Assessment Scale were used in the present study. The study was commenced after obtaining approval from institutional ethics committee. The data was then analysed with parametric or non parametric tests using (mean±Standard Deviation (SD), median, Fisher’s-exact test, Friedman’s Analysis of Variance (ANOVA) test, Wilcoxon matched pair signed-rank test). Data collected and then statistically analysed by using WPS Excel version 2021 and GraphPad Prism version 9 software. Results: Total IPD patients were found to be 111 in the present study with a mean age of IPD patients as 61.85±7.20 years. Incidence of WO in the present study was found to be 40.5% among IPD patients. Most common characteristic of WO was found to be tremor in 104 (28.8%) patients followed by slowness of movement in 63 (17.5%) patients. WHO-UMC scale and Naranjo causality assesment scale both revealed 36.4% ADRs were probable category and 63.6% were possible category. MDS-UPDRS Score, PDQ-39 Score, MMAS-8 score significantly (p-value <0.05) improved during the course of treatment. Conclusion: Dose adjustment of syndopa was mostly used in the management of WO phenomenon and significant improvement in the quality of life of the patients was seen.

A Pilot Study on Presence of Parkinson’s Disease Risk Gene PARK7 in Population of West Bengal, India: A Preliminary Observation

Debasmita Chatterjee, Krishnendu Paira, Banhishikha Singh, Satadal Das

Introduction: The neurodegenerative Parkinson’s Disease (PD) is associated with different risk genes along with some environmental factors. Till date, there are few identified genes which play a pivotal role in the early onset of PD among the general population. Aim: To screen the presence of different risk genes of Parkinson’s disease along with associated environmental factors among randomly selected 62 urban participants. Materials and Methods: The present randomised control trial single blind pilot study was conducted in the Department of Biotechnology, Heritage Institute of Technology, Kolkata, West Bengal, India, from March 2021 to June 2021. The study participants were informed about the study and blood was collected from them. The genomic Deoxyribonucleic Acid (DNA) extraction was carried out following phenol chloroform extraction protocol and Polymerase Chain Reaction (PCR) was done with specific primers of the risk genes namely, Parkinson Disease 1 (PARK1) Alpha-synuclein (α-synuclein), Parkinson Disease 2 (PARK2) (Parkin), Parkinson Disease Protein 7 (PARK7) or DJ -1 and PINK 1. Protein Deglycase-1 (DJ-1) and PTEN Induced Kinase 1 (PINK1). The statistical analysis of the findings was done using Statistical package for the Social Sciences (SPSS) software version 21.0. Results: Out of 62 particpants, 47 were males and 15 were females and the age distribution of the participants was in between 21 years to >60 years. After obtaining specific band in agarose gel electrophoresis, 35 positive cases of PARK7 gene and one positive case of PARK2 gene were identified. Conclusion: There was a statistically significant association of different bacterial and viral infections with the PARK7 gene positive cases. PARK7 gene responsible for early onset of PD is significantly prevalent in the general population of West Bengal.

Content Validation of Questionnaire for Survey on Practice Preferences of Indian Anaesthesiologists in Difficult Intubation and “Cannot Intubate, Cannot Ventilate” Situations (CICV)

Govardhane Balasaheb Tukaram, Vyas Varsha, Arora Sanya, Vanchula Srinivasan

?Introduction: American Society of Anaesthesiologists (ASA) and Difficult Airway Society (DAS) have provided guidelines on management of difficult intubation and Cannot Intubate, Cannot Ventilate (CICV) situations. There have been many advances in equipment available to anaesthesiologist in difficult airway like Supraglottic Airway Devices (SGA), Video-Laryngoscope (VL) and optical stylet. The knowledge and practice of these guidelines are important for patient safety in difficult airway scenario. Aim: To validate the questionnaire to assess practice preferences in difficult intubation and CICV in Indian anaesthesiologist. Materials and Methods: This questionnaire-based observational survey was carried out between April 2021 to June 2021 at Department of Anaesthesia, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India. Nineteen questions were framed based on the literature related to difficult intubation and CICV practices. The questionnaire was sent to 20 experts to grade each question on relevance, clarity, simplicity and ambiguity on a likert scale of 4 as provided in information sheet. Sixteen out of 20 experts responded. Nineteen questions were framed based on the literature related to difficult intubation and CICV practices. The questionnaire was expanded to 22 questions after pilot testing with 10 senior expert anaesthesiologists suggestion of including the question on apneic oxygenation. The collected responses were used to calculate Item-wise Content Validity Index (I-CVI), Scale-wise Content Validity Index (S-CVI) and Modified Kappa Statistics (MKS) in Microsoft excel sheet. Results: The S CVI for relevance, simplicity, clarity and ambiguity was 0.77, 0.77, 0.77 and 0.73, respectively. S CVI/average or Average Congruency Percentage (ACP) was 0.95, 0.95, 0.95 and 0.94 for relevance, simplicity, clarity and ambiguity, respectively. Question 4, 14, 20, 22 received I-CVI of 0.75 in terms of relevance, clarity, simplicity and ambiguity and modified as per experts instructions. Conclusion: The survey questionnaire developed to assess practice preferences in difficult intubation and CICV fulfilled the content validity criteria both by qualitative and quantitative analyses.

Comparison of Hearing Impairment among Healthy and High-risk Neonates at a Tertiary Care Hospital, Rajasthan, India: A Cross-sectional Study

Suresh Kumar Yadav, Akansha Sisodia, Shubha Tak, Achala Arya, Kiran Yadav

Introduction: Hearing impairment is caused by damage in the inner ear (can be even birth defect), ear infection, ruptured eardrum and so on. It can be prevented using early detection thus, helps in avoiding severe psychosocial, educational, and linguistic repercussions. It is necessary to diagnose hearing impairment before six months of age to prevent future delays in speech and language development. Aim: To determine the prevalence of hearing impairment in high-risk neonates and to establish the fact that, these neonates have higher prevalence of hearing impairment as compared to normal population. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Jawaharlal Nehru Medical College and Hospital, Ajmer, Rajasthan, India. The duration of the study was six months, from December 2012 to May 2013. A total of 500 babies including 297 normal and 203 high-risk babies were enrolled into the study. All the neonates were screened using Behavioural Observation Audiometry (BOA) and Distortion Product Oto-acoustic Emission (DPOAE) preferably within three days of life. Those, who failed under this test, underwent for Brain stem Evoked Response Audiometry (BERA). Data was collected in the Microsoft Excel and analysis done by Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the newborns on admission, was 3.86±4.25 days and the mean weight was 2560±510 g. Out of 500 newborns screened, 58 babies had abnormal results with the first screening test. When these 58 babies subjected to BERA, eight babies showed Hearing Loss (HL). Sepsis, Neonatal Intensive Care Unit (NICU) stay more than five days and use of aminoglycosides more than seven days were the important risk factors associated with hearing impairment. Prevalence of hearing impairment in the present study was came out to be 16/1000. This finding was statistically significant with p-value <0.05. Conclusion: There was high prevalence of hearing impairment in high-risk newborns, majority of which were bilateral. The authors recommend multistage screening in all newborns at birth or within month’s time at all level of healthcare facility. Newborns with sepsis, NICU stay more than five days and use of aminoglycosides more than seven days should have mandatory audiologic evaluation at discharge.

Quality of Life and Cost of Illness in Patients with Hand Dermatitis: A Cross-sectional Study

Introduction: The high incidence, severity, and chronicity of hand dermatitis can lead to a massive impact on the Quality of Life (QoL). Despite its medical and socioeconomic importance, there is a paucity of data that addresses the cost-of-illness, economic factors, and its effect on the QoL in patients with hand dermatitis. Aim: To estimate the Dermatology Life Quality Index (DLQI) and cost-of-illness in patients with hand dermatitis. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department (OPD) of Dermatology at RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India. The duration of the study was four months, from September 2022 to December 2022. A total of 82 subjects with the skin condition of hand dermatitis. The QoL (DLQI questionnaire) and cost-of-illness were estimated. The economic burden of hand dermatitis was measured by its direct and indirect costs. Statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 22.0 and the comparison was done using t-test and Analysis of Variance (ANOVA) test. Results: The mean age of the study participants was 39.76±13.30 years with 34 males and 48 females. Eczema was the most common hand dermatitis, seen in 47 (57.3%) patients followed by psoriasis. The average total cost of the illness was Indian Rupee (INR) 5725.29 per individual among all patients, with indirect costs catering to 63.75% of total costs. The average total cost of the illness was INR 6105.03 and INR 5456.31 per individual among male and female patients, with indirect costs (INR 3976.76) catering to 65.14% in males and (INR 3418.75) catering to 62.66% of total costs among females. DLQI revealed social embarrassment had a very much impact seen in 36 participants (43%) followed by disturbances in social and leisure activities seen in 23 participants (28%). Conclusion: Hand dermatitis is distressing to the patient, which can lead to poor QoL. Cost of illness studies shed light on elements, that contribute to high expenses associated with this frequently devastating condition, aiding in its treatment or prevention.

ALK-positive Large B-cell Lymphoma: A Clinicopathologic Retrospective Descriptive Study from a Tertiary Care Cancer Centre in India

Introduction: Anaplastic Lymphoma Kinase (ALK) positive Large B-Cell Lymphoma (ALK+ LBCL) is a very rare aggressive B-cell lymphoma presenting significant diagnostic challenges due to their rarity and unique immunophenotypic features. ALK is a tyrosine kinase receptor and is expressed by ALK+ LBCL due to ALK rearrangement. Aim: To analyse the histopathological features including morphology and immunophenotype, clinical details, pattern of care, Progression Free Survival (PFS) and overall survival of cases diagnosed as ALK+ LBCL. Materials and Methods: This clinicopathological retrospective descriptive study was conducted in the Department of Pathology at a Tertiary Care Cancer Centre, Thiruvananthapuram, Kerala, India. The duration of the study was six months, from January 2022 to June 2022. All the cases of ALK+ LBCL were diagnosed over a period of 10 years, from January 1st 2010 to December 31st 2020. The cases of LBCL diagnosed during the 10 year period were reviewed. Clinical details were obtained from the case sheets of the cases diagnosed as ALK+ LBCL and summarised. Data collection variables included age, sex, stage, nodal and extranodal status, bone marrow, Central Nervous System (CNS) involvement, haemoglobin, Total Leukocyte Count (TLC) and platelet count, Lactate Dehydrogenase (LDH) value, performance status, date of diagnosis, date of treatment started, date of progression, date of last follow-up, date of death (if dead). Review of Haematoxylin and Eosin (H&E) sections and immunohistochemical slides were done and observations were recorded. Descriptive statistics was used to summarise the basic features of the dataset and Kaplan-Meier method was used for calculation of survival. Results: The age of study participants ranged from 16-56 years. During the 10 year period, LBCL accounted for 2415 cases. Among these, ALK+ LBCL constituted 6 (0.25%) cases. There was a male predilection (n=5). Blood counts were normal except for anaemia in three patients. LDH was raised in all the patients. Advanced stage disease was present in two patients. Histopathologically, tumour cells in all the cases showed plasmablastic morphology. Immunohistochemistry (IHC) revealed plasma cell immunophenotype and positivity for ALK in all the cases. Cytokeratin (CK) and Epithelial Membrane Antigen (EMA) were positive in three cases simulating carcinomas. Six year overall survival and PFS in the present study was 50% and 33.3%, respectively. Conclusion: Careful interpretation of the morphology and immunophenotype is essential for diagnosis of ALK+ LBCL, as it can be easily misdiagnosed as a non haematological malignancy thus, affecting the treatment and prognosis in these patients.

Online Biostatistics Teaching to Medical Undergraduates by Comparing Google Classroom Module with Online Lecture during COVID-19 Pandemic: An Educational Interventional Study

Sabitha Rose Jacob, Tom Wilson

Introduction: Coronavirus Disease-2019 (COVID-19) lockdown was an opportunity for starting online medical education in Kerala, India. It was a challenge to teach the core competency biostatistics online considering the unfamiliarity and possible network issues. Aim: To assess the learning and student satisfaction of biostatistics teaching, by comparing Google classroom module and online lecture, while teaching phase-2 Bachelor of Medicine, Bachelor of Surgery (MBBS) students. Materials and Methods: This was a randomised educational interventional study done in the Department of Community Medicine, Government Medical College, Manjeri, Kerala, India, from December 2020 to September 2021. A total of 89 students of phase-2 MBBS were randomly divided into two groups as online lecture group and Google classroom group and five sessions were conducted. For the lecture group, classes were conducted via Google Meet using PowerPoint presentations and for the other group, PowerPoint with audio and worked-out examples were provided in Google classroom. Immediate and retention scores of academic performance and satisfaction level were assessed using Multiple Choice Questions (MCQs). Mann-Whitney U test using Statistical Package for the Social Sciences (SPSS) software version 28.0 were done for analysis. Results: Of total 89 students participated, the mean age of the study population was 21.2±0.73 years, and there were 62 (69.7%) females and 27 (30.3%) males. Academic performance was similar for both groups in most of the immediate assessments, except activity on making graphs (p-value=0.001). In delayed assessment using median scores, the Google classroom group (110, IQR: 100-140) performed significantly better compared to the online lecture (100, IQR: 60-130) with (p-value=0.042). Regarding satisfaction, 68.3% of Google classroom students were satisfied, compared to 52.4% of the online lecture group. The flexibility to learn at own place, pace, and time was the main advantage of the Google classroom, while the need for self-motivation was the disadvantage. Direct interaction was the advantage of online lectures and inability for simultaneous doubt clarification and to attend at fixed timing was the disadvantage. Conclusion: Online teaching of biostatistics was effective and student satisfaction level was good. Google classroom module can be considered as a supplement for traditional teaching.

Preoperative Nebulisation with Dexmedetomidine to Prevent Postoperative Sore Throat in Patients Undergoing General Anaesthesia

Subha Teresa Jose Vazhakalayil, Shilpa Kore, Anilin Joey, Deepu Palal

Introduction: Several pharmacological and non-pharmacological ways have been used to prevent Postoperative Sore Throat (POST). Postoperative Sore Throat (POST) can be prevented with or without medical management. Dexmedetomidine is a selective alpha 2 adrenergic agonists which can be used for preoperative nebulisation to prevent POST. Dexmedetomidine absorption will be greater through transmucosal route as it is a highly lipid soluble agent. It is a highly lipid soluble agent with good systemic absorption during transmucosal administration. Aim: To assess the efficacy of dexmedetomidine nebulisation in reducing POST in patient who require general anaesthesia with endotracheal intubation. Materials and Methods: This randomised control study was conducted from January 2022 to March 2022. There were 60 patients separated into two groups and 30 patients in each. The patients were of age more than 18 years and belonged to American Society of Anaesthesiology (ASA) grade I and II, posted for elective surgery under general anaesthesia. Group D was given dexmedetomidine 50 mcg (1 mL) with 3 mL of saline and made it total volume of 4 mL nebulisation and Group C was given 4 mL of saline nebulisation. Sore throat was evaluated at 0, 2nd,4th,6th,12th and 24th hour after extubation, during the postoperative period. The recorded data was analysed using the Statistical Package for Social Sciences (SPSS), 21 version. Results: Mean age (SD) of patients in group D was 33.5±12.9 years and that in group C was 36.83±14.5 years (p-value=0.23). During postoperative period, the severeness of sore throat was remarkably lesser in Group D especially from 4th hour upto 24th hour. Severeness of POST was remarkably lesser in group D compared to group C patients over the 4th-24th hours. Conclusion: Dexmedetomidine nebulisation given prior to surgery is beneficial in reducing POST, with minimal haemodynamic disturbance. Dexmedetomidine in nebulised form is therefore a safe option for lowering POST.

Vitamin-D Levels of Patients with ST-elevation Myocardial Infarction and Association with In-hospital Prognosis: An Exploratory Observational Study in Southern India

Introduction: The role of vitamin-D in various diseases, including heart disease, has been a subject of interest in recent years. Many studies revealed low vitamin-D status in patients with Acute Coronary Syndrome (ACS). Studies have shown statistically significant low Vitamin-D levels in patients with Myocardial Infarction (MI) in recent years with some studies showing association of vitamin-D deficiency with worse outcome in patients with severe deficiency. Aim: To determine serum vitamin-D levels in patients with acute ST-Elevation Myocardial Infarction (STEMI), and its association with in-hospital prognosis. Materials and Methods: An exploratory observational study was conducted in 100 patients with STEMI consulting a General Medicine Department, JSS Hospital (Tertiary Healthcare Centre), Mysuru, Karnataka, India, from May 2015 to June 2016. The patients were followed-up for in-hospital prognosis. Serum vitamin-D was estimated by Enhanced Chemiluminiscence Immunoassay (ECLIA) method. Electrocardiogram (ECG), Echocardiogram (ECHO) and Coronary Angiogram (CAG) were done in all patients using standard procedures. In-hospital prognosis of the subjects with vitamin-D deficiency and those with normal vitamin-D levels were compared. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Of total 100 patients, majority (n=59, 15.36%) were in the age group of 50-69 years and there were 81 males and 19 females. The results showed 72% of the subjects were deficient and 19% had insufficient vitamin-D levels, therefore, a total of 91% of the STEMI patients had abnormally low vitamin-D levels. Those with Diabetes Mellitus (DM) (n=52) and past Ischaemic Heart Disease (IHD) (n=9) had significantly low vitamin-D levels, suggesting that the association of vitamin-D deficiency with these risk factors may also contribute to the role of vitamin-D deficiency in STEMI. Among those with cardiac failure (44%), 86.3% had deficient and 11.6% had insufficient vitamin-D levels. Conclusion: Vitamin-D deficiency was seen in majority of the STEMI patients. Significantly deficient level of vitamin-D was observed in STEMI patients who progressed to cardiac failure (44%) as a complication.

Correlation of Arch Width and Vertical Facial Morphology in Untreated Adults at a Tertiary Care Centre: A Cross-sectional Study

Smita Kumari, Priyanka Niranjane, Ranjit Kamble, Kushal Taori

Introduction: The vertical dimension of a face is crucial in determining facial aesthetics and harmony. It is important for the orthodontist to understand the relationship between dental arch width and facial morphology for correct diagnosis and proper treatment plan. Aim: To determine the relationship between the vertical face pattern, dental arch width and also, to compare arch widths among both untreated female and male adults. Materials and Methods: This quantitative cross-sectional study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics, at Sharad Pawar Dental College, Sawangi, Wardha, Maharashtra, India. The duration of the study was one month, from June 2019 to July 2019. Dental casts and lateral cephalograms were collected from 50 untreated adults (25 males and 25 females), aged between 18-30 years, who had minimal spacing, crowding and no crossbite. On every patient’s cephalogram, the angle between the plane of the mandible to the cranial base anterior Sella Nasion (SN) angle was calculated. Intercanine, intermolar, and interpremolar widths were measured on dental casts. Females and males arch width were compared. The significance of the differences was assessed using Student’s t-test, one-way Analysis of Variance (ANOVA) test and regression analysis. Results: The mean age of male study participants in the study was 24.44±5.04 years, whereas, mean age of females was 24.88±3.08 years. There were 25 males and 25 females of 18-30 years with mean age of 24 and 25 years, respectively. Arch widths of males were found to be significantly greater than, those of females (p<0.05) and it was observed that, interarch width decreased significantly as the Sella Nasion-Mandibular Plane (SN-MP) angle increased. Regression analyses of male subjects revealed a significant positive relationship between the SN-MP angle. Whereas, the SN-MP angle and width of maxillary first premolar’s buccal cusp tip and the width of the second premolar (most buccal and buccal cusp tip), was found to have a strong correlation in female subjects. Conclusion: It was found that, the width of the dental arch is related to vertical face morphology and gender. During orthodontic therapy, it is recommended to use individualised archwires based on each individual’s pretreatment arch shape and width.

The Prevalence of Malocclusion among Six-and Nine-year-old School-going Children of Visakhapatnam: A Cross-sectional Study

Usha Kiran Vudata, Narsimha Rao V Vanga, Srinivas Kumar Chandrabhatla

Introduction: Malocclusion profoundly impacts a child’s emotional well-being and affects an individual’s quality of life. Early identification improves the chances of organising preventive and interceptive treatment to limit the intensity of developmental aberrations. The data for malocclusion among children of Visakhapatnam is lacking. Aim: To study and evaluate the prevalence of malocclusion and ascertain gender dimorphism among six and nine-year-old school-going children of Visakhapatnam Materials and Methods: A cross-sectional, double-stage sample study was conducted among 616 school-going children of Visakhapatnam, Andhra Pradesh, India, by a single calibrated examiner using a modified Index for Preventive and Interceptive Orthodontic Needs (IPION). IBM Statistical Package for the Social Sciences (SPSS), version 25.0, was used to analyse data and Pearson’s Chi-square test to elicit gender differences in the prevalence of malocclusion traits. Results: Prevalence among six-year-old children: interproximal caries-38.4%, premature tooth loss-10.1%, supernumerary teeth-0.3%, upper molar rotation-0.3%, lower molar tipping-2%, anterior crossbite-2.7%, posterior crossbite-0.7%, overjet more than 3 mm-5.1%, overbite more than 2/3rd-8.4%, open bite-2%, incompetent lips-13.8%. Prevalence among nine-year-old children: interproximal caries-49.5%, premature tooth loss-8.8%, active frenum-2.8%, supernumerary teeth-0.6%, diastema-3.4%, upper molar rotation-2.2%, lower molar tipping-5%, impended eruption of first permanent molar-1.3%, overjet more than 3 mm-11%, overbite more than 2/3rd-12.5%, open bite-2.2%, anterior crossbite-8.2%, posterior crossbite tendency-3.1%, Class I-75.6%, Class II-18.8%, Class III (functional shift)-0.6%, Class III (no functional shift)-3.76%, incompetent lips-16.3%. Conclusion: Children from both cohorts demonstrated malocclusion traits. The nine-year-old group had greater prevalence for all components examined except premature tooth loss. No statistically significant gender dimorphism was found in both cohorts.

Comparative Evaluation of Periapical Healing Outcome Following Non Surgical Endodontic Treatment in Single-visit versus Multiple-visit in Type 2 Diabetes Mellitus Patients: A Randomised Clinical Study

Introduction: Apical periodontitis is very common in those with diabetes mellitus. Diabetes alters immunity, which impacts how periapical tissue heals. The decision between one-visit and multiple-visit root canal therapy is currently up for debate. Aim: To compare periapical healing following single-visit endodontic therapy and multiple-visit endodontic therapy in type 2 diabetic patients by clinical assessment. Materials and Methods: The present randomised single-blinded clinical trial was conducted in the Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from December 2017 to October 2019. A total of 46 patients having type 2 diabetes, indicated for root canal treatment participated in the study and were randomly split into two groups: group I: Single-visit endodontic treatment and group II: Multiple-visit endodontic treatment. Thereafter, endodontic treatment was carried out on all the patients and the patients were recalled for evaluation at 1-week, 3-month and 6-month time intervals. The clinical assessment was done based on the absence of pain, swelling and sinus tract formation. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: Results showed that the success rate based on clinical assessment at one week for a single-visit and multi-visit group was 56.52% for both the groups and at three months 90.47% and 86.36%, respectively. At six months, the single-visit group reported 100% success, while the multi-visit group reported 95% success. However, the difference between the groups was not statistically significant. Conclusion: Within the limitation of the study, it was concluded that clinically, a higher success rate was found after six months in patients having type 2 diabetes mellitus who were treated in a single-visit, which was not statistically significant.

Diluted Home Bleach as a Preprocedural Mouthrinse Prior to Ultrasonic Scaling: A Non Randomised Clinical Trial

Jom T Kizhakkel, RM Baiju, N Raseena Beevi

Introduction: The benefit of mouth rinsing with an antiseptic prior to aerosol generating dental procedures has been reported and widely accepted. Chlorhexidine (CHX), the widely employed antiseptic mouthrinse is not without side-effects. Diluted home bleach (sodium hypochlorite) has been in use as an antiseptic mouthrinse and its role in plaque control is well documented. It is safe, less expensive and readily available. Aim: To compare the aerosol microbial load after ultrasonic scaling between three preprocedural rinses namely 0.1% sodium hypochlorite (diluted home bleach), 0.2% CHX and distilled water. Materials and Methods: A non randomised clinical trial was conducted in the Postgraduate Clinic, Department of Periodontics, Government Dental College, Kottayam and Department of Microbiology, Government Medical College, Kottayam, Kerala, India, from April 2021 to September 2021. Study included sixty systemically healthy adults {Full-mouth Plaque Score (FMPS) and Full-mouth Bleeding Score (FMBS) >25%, with atleast one periodontal pocket >4 mm in each quadrant} who were divided into three Groups (A, B, C) of 20 each receiving diluted home bleach, CHX or distilled water, respectively as preprocedural rinse. Subjects rinsed 15 mL of solution for 30 seconds, 10 minutes prior to ultrasonic scaling. Blood agar plates kept at patient’s chest and doctor’s chest locations to collect aerosols were incubated for 48 hours and microbial Colony Forming Units (CFUs) counted. Analysis of Variance (ANOVA) was used to compare the amount of CFUs at the two sites between three groups. Independent t-tests were used to compare the intragroup CFU counts between two sites. Results: The mean age of group A, group B and group C was 45.15±7.01 years, 41.9±9.96 years and 43.2±7.93 years, respectively. There were 13 males and 7 females, 7 males and 13 females and, 11 males and 9 females in group A, group B and group C, respectively. There were more CFUs in patient’s chest location sample compared to doctor’s chest location in all three mouthrinse groups. For Sodium hypochlorite (NaOCl), mean difference was 43.850 (95% CI 15.2-72.4), for CHX 45.800 (95% CI 25.9-65.6), for distilled water 56.650 (95 % CI 20.2-93.0), respectively which were statistically significant (p-value <0.05). The home bleach and CHX groups showed significantly fewer CFUs than distilled water on both locations. On comparison with CHX, diluted home bleach demonstrated fewer CFUs, but this difference was not statistically significant. Conclusion: Diluted home bleach and CHX preprocedural rinses were comparable in terms of CFU counts in dental aerosols generated during ultrasonic scaling. Diluted home bleach mouthrinse is safe, economical and readily available in every household.

Spinal Anaesthesia for Ambulatory Perianal Surgeries: A Comparison between Short Acting and Long Acting Local Anaesthetics

Navin Gandhi, Mohan Sundaram, Ashok Kulasekhar, Subramaniam Anand, Arun Kumar

Introduction: Chloroprocaine (ester group) is a preservative-free local anaesthetic which is available as isobaric solution. It is being recently popularised in spinal anaesthesia for its shorter duration of action which plays a significant role in the early ambulation and voiding functions, which is the primary essence in ambulatory surgery. Intrathecal Bupivacaine is the most commonly used drug for its block characteristics, taking into account not only the fast initiation of sensory and motor blockade but also faster sensory and motor regression. Aim: To compare the block characteristics between 1% Chloroprocaine and 0.5% Bupivacaine in patients undergoing perianal surgeries under spinal anaesthesia. Materials and Methods: This randomised, interventional double blinded study was carried out in Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India, from April 2020 to August 2021. The patients were split into two groups of 34 each. Group 1: Patients received 30 mg of 1% Chloroprocaine intrathecally. Group 2: Patients received 10 mg of 0.5% Bupivacaine intrathecally. In both the groups the onset, duration of both sensory and motor blocks, intraoperative haemodynamic, two segment regression time, time to ambulation and micturition, the time to eligibility for discharge from hospital was evaluated. Independent sample t-test, Chi-square test and Fisher’s-Exact test were employed to compare the distribution of qualitative variables between the groups. Results: Total of 68 participants 31 (45.6%) males and 37 (54.4%) females), 34 in each group 1 and group 2 were analysed. Both groups contained maximum patients in >45 years age group, 12 (35.2%) in each group. Demographic and anthropometric parameters of patients in both the groups were comparable. Mean time of ambulation after spinal anaesthesia in the Group 1 was 137.65±9.15 minutes and in Group 2 was 193.38±8.14 minutes (p-value <0.05). Mean time taken to return of voiding function the Group 1 was 157.06±16.05 minutes and in Group 2 was 213.53±10.26 minutes (p-value <0.05). Mean time taken for Post-Anaesthetic Discharge Scoring System (PADSS) score >9 in Group 1 was significantly less (165.29±13.59 minutes) than Group 2 (219.41±9.52 minutes). Mean time duration for request of first rescue analgesic in Group 1 was significantly faster (104.71±8.69 minutes) than Group 2 (157.79±8.81 minutes). There was no significant difference in haemodynamic changes between the study groups. Conclusion: Chloroprocaine has proved to be better than Bupivacaine. It has proven to provide adequate surgical anaesthesia, it leads to early regression of motor and sensory blocks, faster un-assisted ambulation and micturition. Time to rescue analgesia was earlier in the Group 1 when compared to Group 2.

Determination of Renal Volume using Ultrasonography and its Correlation with Renal Function: A Cross-sectional Study

Ankit Sandhu, Sandeep Gupta, Dilip Kumar Pal

Introduction: Renal length and volume are important indicators for the presence or progression of disease in urology and nephrology. Estimation of renal volume by Ultrasonography (USG) has clinical utility for the physician, nephrologist, and urologist. Aim: To measure individual renal volume by ultrasonography and determine its relationship with renal function as measured by the Diethylene Triamine Penta-acetic Acid (DTPA) in normal adults. Materials and Methods: It was a cross-sectional study conducted on 50 patients who underwent DTPA scans both in Outpatient (OPD) and In-Patient Department (IPD) in the Department of Urology, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, West Bengal, India, from January 2020 to December 2020. All the transplant donors who underwent donor nephrectomy were included in the study. A sonographic assessment was done and the Glomerular Filtration Rate (GFR) was calculated by Technetium (Tc)-154 DTPA. The primary outcome was to determine the relationship between renal volume with renal function in normal adults. The secondary outcome was to measure individual renal parameters sonographically. They were assessed for correlation between renal parameters (mainly renal volume) and DTPA using Pearson’s coefficient. Results: The age range of the subjects was 18-70 years. GFR calculated by DTPA for the right kidney had a better correlation with renal volume (r=0.241) on the right and 0.162 on the left, both with a p-value of 0.001. GFR of the left kidney had a better correlation with left kidney volume (r=0.184) than right kidney volume (r=0.130). No correlation was found between GFR with renal Anteroposterior (AP) dimension, renal width, and renal length. The kidney volume was more significant on the left-side (r=0.351) than on the right kidney (r=0.263). Conclusion: Renal volume correlated well with renal function. Sonographic assessment of renal volume rather than renal length would serve as a tool to evaluate renal status for evaluation and follow-up.

Comparative Evaluation of Apical Debris Extrusion from the Root Canal using Hand Files, Continuous Rotary Files and Reciprocating File System: An In-vitro Study

Introduction: Root canal preparation is an important step of endodontic therapy. For successful endodontic therapy apical extrusion of debris through the apical foramen into the peri-radicular region should be minimal to avoid postoperative complication such as flare-ups. Aim: To evaluate in-vitro, extrusion of apical debris from the root canal using continuous rotary files (using multiple files system and single rotary file system), reciprocating file system and hand files. Materials and Methods: This in-vitro research was carried out in the Department of Conservative Dentistry and Endodontics, MM college of Dental Sciences and Research, Mullana, Ambala, Haryana, India, from November 2017 to January 2018. A total of 120 human mandibular premolar teeth that were caries free and single-rooted were split into four groups (each group with n=30) Group I: Hand ProTaper, Group II: Protaper Universal, Group III: F360 and Group IV: WaveOne Gold file system. The root canal was instrumented according to manufacturer’s Instructions; and standardised irrigation with distilled water was performed. The Myers and Montgomery’s Model was employed to gather irrigant and debris that had been apically ejected. The analysis of data obtained was done using Posthoc Bonferroni test, One-way Analysis of Variance (ANOVA) and paired t-test. Results: The findings indicate that all instrumentation techniques produced significant amount of extruded debris and irrigant. The mean apical debris extrusion using the One-way ANOVA test showed significant difference (p-value <0.001). WaveOne Gold file group showed least (0.0005±0.0001 mg) and Hand ProTaper file showed maximum (0.0017±0.0002 mg) apical debris and irrigant extrusion. Conclusion: Less apical extrusion of irrigant and debris was observed in the engine-driven nickel-titanium systems than manual technique. Reciprocating file system when compared with hand and continuous rotary file system showed less debris extrusion.

Role of Computed Tomography Scan in the Assessment and Management of Blunt Splenic Trauma in a Tertiary Care Hospital, Assam, India

Introduction: Trauma is the most common cause of mortality and morbidity in young individuals. Penetrating splenic injuries are more common than blunt injuries. The management of blunt splenic trauma has substantially evolved over the last few decades, moving from routine splenectomy to preserving the spleen wherever feasible. Aim: To determine the role of Multidetector Computed Tomography (MDCT) in the diagnosis and treatment of blunt splenic trauma. Materials and Methods: This hospital-based retrospective study was conducted in Department of General Surgery, Tezpur Medical College and Hospital, Tezpur, Assam, India, from 1st October 2021 to 31st August 2022. During the study period, there were 132 cases of blunt trauma abdomen. Among them, 122 patients had undergone MDCT of the abdomen. The clinical data of these 122 patients were recorded. Of these 122 patients who underwent MDCT, 21 had splenic injuries. The patients who were treated conservatively were traced and the outcome of the treatment on follow-up was taken, from the clinical notes. The preliminary MDCT findings of the patients were correlated with the final diagnosis and treatment. Fisher’s-exact tests and Chi-square were used for statistical analysis. Results: The 21 splenic injuries in this study were classified based on the American Association for the Surgery of Trauma (AAST) grading scales for organ injury, and 14 (66.67%) had Non Operative Management (NOM). Of the four patients with Contrast Material Extravasation (CME), all of them had undergone laparotomy related to the spleen (100%) and demonstrated active bleeding during surgery, but only three of the remaining 17 patients without CME (17.65%) required laparotomy related to the spleen; the difference was statistically found to be significant (p<0.01). Conclusion: The accurate diagnosis provided by MDCT evaluation of blunt splenic injuries helps in formulating the right approach for better management.

Oral Zinc as an Adjunct in the Treatment of Enteric Fever: A Randomised Double-blinded Controlled Trial

Introduction: Enteric fever is an important tropical disease which takes an average of five days for defervescence even with effective antibiotic therapy. Zinc has been successfully used as an adjuvant in diarrhoeal disease. If addition of oral zinc can lead to reduction in time to defervescence, it will be a useful adjuvant in the therapy of enteric fever. Aim: To determine the effect of oral zinc supplementation, along with standard antibiotic therapy, for early defervescence among children with enteric fever. Materials and Methods: This double-blinded, randomised controlled trial was conducted in the Department of Paediatrics, ESICMC and PGIMSR, Chennai, Tamil Nadu, India from November 2014 to August 2016. A total of 58 children aged <12 years with enteric fever were included and were randomised to receive 40 mg elemental zinc per day (n=29) or placebo (n=29) for one week. All children received intravenous ceftriaxone (75 mg/kg every 12 hours) until five days after defervescence. The main outcome measures studied were time taken for defervescence of fever and resolution of toxaemia. Kaplan-Meier survival analysis was used to compare differences in the time to resolution of toxaemia and defervescence of fever between the two groups and the log rank test was used to test for significance. Results: The mean age of the children of the two groups was 6.48±3.15 years and 7.55±2.59 years, respectively. The mean time for fever defervescence was shorter among the zinc supplemented children than among the children in the control group (2 vs 3 days, p-value=0.043). Resolution of toxaemia was noted earlier in the zinc group than in the control group (75% vs 43%, p-value=0.054). Conclusion: Zinc when used as an adjunct along with standard antibiotic therapy in children with enteric fever, resulted in earlier defervescence of fever.

Utility of COX-2 as Immunohistochemical Prognostic Marker in Relation to Various Histopathological Parameters and TNM Staging in Colorectal Carcinoma

Introduction: The most prevalent neoplasm of the gastrointestinal system is colorectal carcinoma. After lung and breast carcinoma, malignant colorectal cancer appears to be characterised by inflammation. Among the numerous recognised indicators of inflammation, Cyclooxygenase-2 (COX-2) has been identified as playing a key role in the early phases of carcinogenesis. Need of the study: The link between higher expression of COX-2 and the early stages of carcinogenesis and cancer development implies that COX-2 might be a target for precancerous colorectal lesion imaging. The present study can be useful in assessment of expression of COX2 in colorectal cancer and it’s correlation with the histopathological grade, nodal status and TNM staging. Aim: To assess the expression of COX-2 in colorectal carcinoma and the association with various histopathological parameters and Tumour Node Metastasis (TNM) staging. Materials and Methods: The current study is an observational, cross-sectional, retrospective, and prospective study that will take place in the Histopathology and Immunohistochemistry unit of the Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India. Sample collection will be done during the the period of August 2021 to July 2024. The study included approximately 60-65 resected specimens from confirmed and planned Colectomy, Hemicolectomy, and Proctocolectomy specimens received in the Department of General Pathology, JNMC. Observations and results will be collected from the immunohistochemistry study by using COX-2 as a prognostic marker in colorectal carcinoma and correlating it with the TNM staging. Statistical analysis will be made by Chi-square test and regression analysis.

Effect of Ballistic Training on Pain, Range of Motion and Strength in Phase II Rehabilitation of ACL Reconstruction: A Research Protocol of a Randomised Controlled Trial

Medhavi Vinod Jagzape, Deepali Patil

Introduction: An Anterior Cruciate Ligament (ACL) injury produces a 5%-40% reduction in quadriceps strength over time. Neuromuscular electrical stimulation is used to help the quadriceps muscle weaken after ACL surgery. The ACL is the primary stabiliser for anterior tibial displacement and the secondary stabiliser for tibial rotation; an ACL-deficient knee can result in devastating consequences like articular cartilage injuries, meniscus tears, functional instability, and the risk of early-onset osteoarthritis. Following an ACL injury, the goal of ACL restoration is to restore functional knee stability. Journals have indicated an increased interest in combining ACL restoration with extra-articular augmentation in recent years. Several studies have demonstrated that, the extra reconstruction not only protects the graft from high loads, but also enhances lateral rotational control. In patients with sore joints after ACL reconstruction, cryotherapy can help by releasing endogenous opiates and decreasing nerve conduction velocity. Exercise performance for the physical qualities of strength and power, like many other sports activities, has a short time element for successful performance. As a result, these workouts are performed at the highest possible speed in the least amount of time. Need of the study: There are many evidences that theraband exercises are essential for the patients with ACL reconstruction. Even in athletes, there are literature, that proves ballistic training is essential for the patients with ACL reconstruction, but there is no literature for the ballistic training in normal population undergoing ACL reconstruction surgery. There is a strong need to perform a study and evaluate them. Aim: To find out effectiveness of ballistic training in phase II rehabilitation on the patients with ACL reconstruction. Materials and Methods: This randomised control trial will be contucted in the Outpatient and the Inpatient Department of Physiotherapy, Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, India, from May 2022 to May 2023. A total of 100 patients with ACL reconstruction will be divided into two groups, one group will receive conventional therapy along with theraband exercises and another group will receive conventional therapy exercises along with ballistic training. Treatment will be given for eight weeks, five days in a week. The assessment will be done on day one of the treatment and at the end of treatment that is 8th week. Student’s t-test and Chi-square tests will be applied for statistical comparison.

Unveiling the Enigma of the Phosphatase and Tensinogen Gene in Cancer and its Potential Role in Oral Cancer- A Narrative Review

Phosphatase and Tensin Homolog (PTEN) is a tumour suppressor gene that plays a vital role in the normal cell cycle. PTEN acts on the cell via the phosphatidyl-inositol-3-kinase pathway which is involved in the process of cell growth, differentiation, migration, and survival. PTEN is most frequently inactivated in human cancers, because of genetic alterations or transcriptional/post-transcriptional modifications. Literature search was done using the keywords “PTEN in cancer” and “PTEN in Oral Cancer” using Pubmed as the database. This article briefly discusses the multiple features of the PTEN gene and its significance in cancer for improving the understanding of the biology of oral carcinogenesis and the potential for future research in this field.

Herbal Dentistry- A Narrative Review

Deepshikha Mehrotra, R Manju

The use of medicinal herbs in dentistry continues to expand rapidly across the globe. Herbal dentistry presents an attractive alternative to conventional synthetic materials. With a shift towards evidence-based dental practice, there is a need for dental clinicians to be fully aware of the alternatives and options currently available to them. This review article provides insight into the various herbal products currently available in dentistry. It provides a better understanding of the mechanism of action of the herbal products used to treat various dental problems. This narrative review identifies and summarises the most common medicinal herbs in various preventive and therapeutic spheres of dentistry. High anti-microbial, anti-inflammatory, antioxidant, and immunomodulatory activities along with wound healing ability and sedative-anxiolytic were identified to be the properties favouring use of these medicinal plants in dentistry. Although the natural alternatives discussed in the current narrative review have shown to be either superior or comparable to the synthetically available options, further long-term in-vivo clinical trials are required to substantiate this evidence and justify the replacement of later with herbal alternatives in dentistry.

Pathophysiology of Allergic Rhinitis with Future Therapeutic Targets- An Update

Ajinkya Sandbhor, Shraddha Jain

Rhinitis is defined by a combination of two or more nasal symptoms (runny or blocked nose, itching, and sneezing). Allergic Rhinitis (AR) occurs when these symptoms are due to Immunoglobulin E (IgE)-mediated inflammation following exposure to the allergen. The current review article has attempted to revisit the pathophysiologic basis of this disease in order to understand the likely therapeutic targets. Controlling histone acetylation with histone deacetylase inhibitors, Deoxyribonucleic acid (DNA) hypermethylation with DNA methyl transferase inhibitors and post-transcriptional gene expression with micro Ribonucleic Acid (miRNA) mimetics which target epigenetic changes, may aid in the treatment of AR. The allergen-induced nasal hypersecretion in allergic patients can also be definitively blocked by vidian neurectomy. Probiotics are non pathogenic microorganisms that are assumed to exert a positive influence on host health and physiology which may aid in the treatment of AR. Reversing or targeting the epigenetic changes in susceptible individuals can help prevent sensitisation of the individual and better treatment outcome in patients with AR, help cure the symptoms and lack of drug dependance.

The Root Causes of Lumbar Canal Stenosis: An Insight with a Narrative Review

Ankit Jaiswal, Rameez Bukhari, Prateek Upadhyay

In the older population, lumbar spinal stenosis is a frequent degenerative condition that can cause clinical symptoms such as neurogenic claudication or sciatica, either with or without low back pain. Anatomically, there are three different forms of lumbar spinal stenosis: central, foraminal, and lateral recess. The relationship between Ligamentum Flavum (LF) hypertrophy and mechanical stress, as seen in segmental instability or disc space expansion, and their correlation with lumbar facet joint arthropathy is still not clear. This review places particular emphasis on the causes like LF hypertrophy, lumbar segmental instability, lumbar segmental motion, disc degeneration, lumbar spine facet joint orientation, facet joint tropism and facet joint Osteoarthritis (OA) in Lumbar Canal Stenosis (LCS) studied in various different studies discovered in various other search databases. The present research will also help surgeons and radiologists to interpret neuroradiological data appropriately for surgery as well as non surgical treatment and get a better knowledge of the architecture of these structures and how they appear on neuroimaging investigations for further proper and apt management of LCS. Additionally, it would assist in creating a diagnostic algorithm for better functional results.

Periodontal Health-The Gordian Knot in Public Health: The Indian Standpoint

Krishnendu Debnath, Swet Nisha, Debanjan Das, Nilanjana Goswami, Sudipto Barai

Oral health is an inherent part of public health and is intricately related to systemic health. The interdependency of oral health and systemic health merges at the knot called periodontal health. Systemic diseases like cardiovascular diseases, metabolic diseases, and autoimmune diseases affect periodontal tissues and there lies a bidirectional relationship between periodontitis and diabetes mellitus. Taking this into consideration, periodontal health maintainance is essential for better systemic health. With the advancing health complications in the present time and due to spatial disparities, periodontal health is taking the shape of a concerning public health problem. India is facing some definitive challenges in terms of the oral healthcare system. Periodontal health assessment needs introduction of oral health programmes focusing on periodontal assessment, oral health policies and promoting education regarding periodontal health. Continous surveilliance of the disease can help us in determing the prevalence of disease, disease progression, early diagnosis, and treatment. This review aims at finding the existing problems addressing periodontal health as a public health issue, key challenges, and possible ways out of this problem.

R-Spondins and Wnt Signalling Pathway: A Periodontal Perspective

NK Savithri, S Sangeetha, Jesintha Mary, PM Gayathri

Periodontitis is a multifactorial chronic condition associated with the formation of a dysbiotic biofilm, leading to inflammation that can modulate cell signaling. R-spondins (Rspos) are cysteine-rich secreted glycoproteins which control a variety of functions which are essential for embryonic development and tissue homeostasis. Numerous studies have explained about their pivotal role in critical developmental regulators, the most important finding being Rspos synergise Wingless/Integration (Wnt) signaling. Novel receptors for Rspos, the Leucine-rich repeat containing G protein-coupled (LGR) receptors, proposed that Rspos potentiate canonical Wnt signaling via these receptors. Here, authors discussed about the Wnt signaling and outlined the biological role of Rspos in tissue development and homeostasis and explore the possibility that Rspos may be used as therapeutic targets. Wnt5a is important for promoting periodontal ligament remodeling and impairing regenerative responses modulated by the Wnt/β-catenin pathway, for alveolar bone formation.

An Update on WHO Classification of Thoracic Tumours 2021- Newly Described Entities and Terminologies

Gyanendra Singh, Anurag Singh, Rushang Dave

The 5th edition of the World Health Organisation (WHO) “Classification of Thoracic Tumours” replaces the previous edition from 2015, which was released in 2021. The new edition includes specific diagnostic criteria for each entity and lays a stronger emphasis on diagnostic molecular pathology. Immunohistochemistry (IHC) was heavily promoted in 2015, as a way to improve classification precision. The book places more attention on molecular pathology developments for all tumour types in 2021. Classification based on microscopic biopsy samples of the characteristics of lung cancer is an alternative to resection-based categorisation. A grading system for invasive non mucinous adenocarcinomas has been developed, using the percentage of distinctive histological patterns found inside each tumour. Lung adenocarcinoma is also predisposed by Tumour Spread Through Air Spaces (STAS). A basaloid variety of Squamous Cell Carcinoma (SCC) and lymphoepithelial carcinoma was added to the SCC group. The ciliated muconodular papillary tumour and thoracic SMARCA4-deficient undifferentiated carcinoma are recent inclusions. Therefore, the following new terms and entities have been added to the WHO classification of 2021: (1) Thoracic SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily a, member 4 (SMARCA4)-deficient undifferentiated tumour; (2) Bronchiolar adenoma/ciliated muconodular papillary tumour; (3) Primary pulmonary hyalinising clear cell carcinoma of lung; (4) Lypmphoepithelial carcinoma; (5) STAS.

Tomato Flu- A New Virus Trending in Children

Pritama Paul, Sritama Paul, Nikhil Era, Kanai Lal Barik, Uttam Kumar Paul

The new tomato flu virus has caused a new wave of concern, particularly in young people, as people try to live with Coronavirus Disease-2019 (COVID-19) infections and the undetected existence of monkeypox infections. The flu virus derives its name from the red blisters that resemble tomatoes and spread throughout the body of an affected person. Children between the ages of one and five and elderly people with compromised immune systems are frequently affected. Mouth ulcers, blisters, rashes, coughing, fever, sneezing, or runny nose, skin irritation, discolouration of the hands and legs, exhaustion, abdominal pains, nausea, vomiting, or diarrhoea, bodyaches, and joint pain are the main warning signs and symptoms of tomato flu. To treat tomato flu, supportive measures and fever-reducing drugs like acetaminophen or ibuprofen may also be administered. Antiviral medicines and immunisations are currently still unable to cure or prevent tomato flu. In order to properly address the epidemic, research should be focused in the future on the readiness of effective treatments and immunisations.

Bicornuate Unicollis Uterus in Recurrent Spontaneous Abortion- A Case Report

Manas Singh Baghel, Surekha Tyade, Yuganshu Bisen

Bicornuate Unicollis uterus is a congenital uterine anomaly due to malformation of the paramesonephric ducts, also known as Müllerian ducts, presenting in 3%-5% of the general population. It is relatively rare to associate uterine anomalies and pregnancy outcomes. Patients are often asymptomatic but can present with secondary infertility, disturbances in menstruation, recurrent early and late pregnancy loss, as well as intrauterine growth restrictions and deaths which can be a sign for the diagnosis of the abovementioned condition. Here, we discuss a case of a 28-year-old female, of low socioeconomic status, presented with a history of white-coloured vaginal discharge and two spontaneous abortions in the last two years. On gynaecological examination, a polyp of 2×2 cm was observed over the anterior lip of the cervix, with curdy white discharge present on per speculum examination. On per vaginum examination, the uterus was found to be anteverted and anteflexed, and the fornices were free. Magnetic Resonance Imaging (MRI) revealed it as a bicornuate uterus, and the patient was managed with septum resection and counseled for a successful future pregnancy outcome.

Assessment and Physiotherapeutic Intervention for Patellofemoral Pain and Muscle Performance Deficits- A Case Report

Patellofemoral pain can lead to knee pain, mobility issues, and deficits in muscle performance. It is caused by mechanical and chemical imbalances within the patellofemoral joint. Physiotherapeutic intervention plays an important role in managing these deficits. In this case, a physiotherapeutic intervention was prescribed based on the International Classification of Functioning, Disability, and Health (ICF) model. The assessment was conducted using the ICF model to describe and organise information on functioning and disability. A 55-year-old female with right peripatellar pain was examined using the ICF model for patellofemoral pain and muscle performance deficits. The components observed were correlated with the ICF model. Based on the ICF-based assessment results, there was a decrease in muscle strength and knee Range of Motion (ROM) along with the presence of pain. Functional activity limitations are present in the form of squatting and stair climbing. Other associated findings are mild patellofemoral swelling and quadriceps wasting. This case study found that muscle performance deficits caused by patellofemoral pain can be managed with an eight-week ICF-based physiotherapeutic intervention that follows the prescribed elements of physiotherapy.

The Effect of Pre-Heating on Fracture Toughness in Three Distinct Composite Resin Systems at Two Different Temperatures: A Protocol for an In-vitro Study

Jay Bhopatkar, Anuja Ikhar, Pradnya Nikhade, Manoj Chandak

Introduction: Composite resins are considered the pinnacle of esthetic restorations, but they have their own disadvantages, such as polymerization shrinkage, low fracture toughness, and the formation of microcracks, all of which eventually results in failure of the restoration. Fracture toughness is an important factor for failure. Warming the same composites to certain temperatures will show drastic improvements in the above-mentioned flaws, especially the fracture toughness. Need for the study: Therefore, the objective of this study is to evaluate and compare the fracture toughness of three different types of composite resin systems at two different pre-heating temperatures. The study aims to provide valuable information to clinicians in choosing the most appropriate restorative material for posterior composite restorations, which can ultimately improve the treatment's success rate and reduce the risk of complications such as secondary caries, postoperative sensitivity and ultimately restoration failure. Objective: In summary, this study will compare and evaluate the fracture toughness of nanohybrid, micro-hybrid, and bulk-fill composite resins pre-heated at 50 degrees Celsius and 60 degrees Celsius. Methodology: The methodology involves dividing 72 freshly extracted premolars with intact occlusal anatomy and fully developed apical foramina into three main groups based on three different composites and further dividing each group into two sub-groups based on two different pre-heating temperatures, with 12 teeth in each group. Each tooth will then be prepared with a Class-II Mesio-Occlusal-Distal (MOD) cavity and receive pre-heated composite restoration according to its assigned group and sub-group. The prepared samples will be tested for fracture toughness using a universal testing machine.

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